St. John’s Lutheran Church 2019 Vacation Bible School Registration

[av_section min_height=’25’ min_height_px=’500px’ padding=’large’ shadow=’no-shadow’ bottom_border=’no-border-styling’ bottom_border_diagonal_color=’#333333′ bottom_border_diagonal_direction=” bottom_border_style=” id=” color=’main_color’ custom_bg=” src=’https://www.stjohnslutheranhatboro.org/wp-content/uploads/BearCreekDayCamp-2-1030×295.jpg’ attachment=’2694′ attachment_size=’large’ attach=’parallax’ position=’top center’ repeat=’contain’ video=” video_ratio=’16:9′ overlay_enable=’aviaTBoverlay_enable’ overlay_opacity=’0.2′ overlay_color=’#000000′ overlay_pattern=” overlay_custom_pattern=”]
[av_heading heading=’SJLC Vacation Bible School Registration 2019′ tag=’h3′ style=’blockquote modern-quote modern-centered’ size=’50’ subheading_active=’subheading_below’ subheading_size=’15’ padding=’0′ color=’custom-color-heading’ custom_font=’#ffffff’][/av_heading]

[av_hr class=’custom’ height=’50’ shadow=’no-shadow’ position=’center’ custom_border=’av-border-thin’ custom_width=’20%’ custom_border_color=’rgba(255,255,255,0.76)’ custom_margin_top=’30px’ custom_margin_bottom=’30px’ icon_select=’yes’ custom_icon_color=’#ffffff’ icon=’ue8bf’ font=’entypo-fontello’]
[/av_section]

[av_section min_height=” min_height_px=’500px’ padding=’small’ shadow=’no-border-styling’ bottom_border=’no-border-styling’ id=” color=’main_color’ custom_bg=” src=” attachment=” attachment_size=” attach=’fixed’ position=’bottom center’ repeat=’stretch’ video=” video_ratio=’16:9′ overlay_opacity=’0.3′ overlay_color=’#000000′ overlay_pattern=” overlay_custom_pattern=”]

[av_two_third first min_height=’av-equal-height-column’ vertical_alignment=’av-align-top’ space=’no_margin’ custom_margin=’aviaTBcustom_margin’ margin=’-60px,0px’ padding=’30px’ padding_sync=’true’ border=” border_color=’#e1e1e1′ radius=’0px’ radius_sync=’true’ background_color=’#ffffff’ src=” attachment=” attachment_size=” background_position=’top left’ background_repeat=’no-repeat’]

[av_textblock size=’15’ font_color=” color=”]

Dates and Times:

Monday, June 24 through Friday, June 28; 9 am to 12 pm.

All children between the ages of 3 years old* through the completion of 6th grade are welcome to register and participate.

*All children must also be potty-trained.

Snacks will be provided daily, but children are responsible for bringing cold bagged lunches each day.

Registration is free and forms can also be found in the Sunday School Office and the Church Office.

215.675.7780 (Pre-K Office),
215.675.2031 (Church Office) or
[av_button label=’stjprek@gmail.com’ link=’manually,mailto:stjprek@gmail.com’ link_target=’_blank’ size=’small’ position=’left’ icon_select=’yes’ icon=’ue805′ font=’entypo-fontello’ color=’theme-color’ custom_bg=’#444444′ custom_font=’#ffffff’]

[av_hr class=’custom’ height=’50’ shadow=’no-shadow’ position=’center’ custom_border=’av-border-thin’ custom_width=’640px’ custom_border_color=’#b02b2c’ custom_margin_top=’12px’ custom_margin_bottom=’30px’ icon_select=’no’ custom_icon_color=” icon=’ue808′ font=’entypo-fontello’]
[/av_textblock]

[/av_two_third][av_one_third min_height=’av-equal-height-column’ vertical_alignment=’av-align-top’ space=’no_margin’ custom_margin=’aviaTBcustom_margin’ margin=’-60px,0px’ padding=’30px’ padding_sync=’true’ border=” border_color=’#e1e1e1′ radius=’0px’ radius_sync=’true’ background_color=’#f0f0f0′ src=” attachment=” attachment_size=” background_position=’top left’ background_repeat=’no-repeat’]

[av_image src=’https://www.stjohnslutheranhatboro.org/wp-content/uploads/Logo_VBS_StJohns.jpg’ attachment=’2357′ attachment_size=’full’ align=’center’ styling=” hover=” link=” target=” caption=” font_size=” appearance=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’][/av_image]

[/av_one_third][av_contact email=’sjlc@verizon.net’ title=’2019 Registration’ button=’Register This VBS Student’ on_send=” sent=’Your message has been sent! Registration will be processed and you will receive confirmation shortly. Contact Stephanie Metheny for more information.’ link=’manually,http://’ subject=’VBS 2019 Registration’ autorespond=” captcha=’active’ form_align=” color=”]
[av_contact_field label=’Student Name’ type=’text’ options=” check=’is_empty’ width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Street Address’ type=’text’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’City’ type=’text’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’State ‘ type=’text’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Zip’ type=’text’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Date of Birth’ type=’text’ options=” check=’is_empty’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Grade Completed in 2019′ type=’text’ options=” check=’is_empty’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Parent or Guardian Name’ type=’text’ options=” check=’is_empty’ width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Relationship to Camper’ type=’select’ options=’Select one, Mother, Father, Guardian, Grandparent, Other,’ check=’is_empty’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Occupation’ type=’text’ options=” check=” width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’E-Mail’ type=’text’ check=’is_email’ options=” multi_select=” av_contact_preselect=” width=”][/av_contact_field]
[av_contact_field label=’Phone Number’ type=’text’ options=” check=’is_phone’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Secondary Parent or Guardian Name’ type=’text’ options=” check=’is_empty’ width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Relationship to Camper’ type=’select’ options=’Select One, Mother, Father, Guardian, Grandparent, Other’ check=’is_empty’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Email’ type=’text’ options=” check=’is_email’ width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Alternate Phone Number’ type=’text’ options=” check=’is_phone’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Emergency Contact Name’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Emergency Contact Relationship To Camper’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Emergency Contact Phone Number’ type=’text’ options=” check=’is_phone’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Health History: Last Tetanus Shot’ type=’datepicker’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Health History: Immunizations (All immunizations required for school are up to date’ type=’select’ options=’Select One, Yes, No’ check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Health History: Date of Last Health Examination’ type=’datepicker’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Health History: Medications (if yes, please fill out dosage/schedule below)’ type=’select’ options=’Select One, Yes, No’ check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Medication Dosage/Schedule (if Applicable)’ type=’textarea’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Medication Permission: Do you give consent for these over-the-counter medications: Tylenol, Ibuprofen, Benadryl, Other’ type=’select’ options=’Select One, Yes, No, I will specify below’ check=’is_empty’ width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Medications Specifications (Please fill out if you answered Other or I will specify)’ type=’textarea’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Medical Allergies’ type=’select’ options=’Select One, Yes, No’ check=’is_empty’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Allergy Specifications ( Enter any relevant information about the camper’s allergies)’ type=’textarea’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Food Allergies’ type=’select’ options=’Select One, Yes, No’ check=’is_empty’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Food Allergy Specifications (Please provide details and important information about the Camper’s food allergies and needs)’ type=’textarea’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Other Allergies or Health Items to be Aware About’ type=’textarea’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Conditions, Illness or Health Concerns ( List any Chronic, physical or mental considerations the Camper has that require our support/awareness during camp participation)’ type=’textarea’ options=” check=” width=” multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Camper’s Insurance Company’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Policy Number’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Insurance Company Phone Number’ type=’text’ options=” check=’is_phone’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Insurance Company Address’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Primary Physician Name’ type=’text’ options=” check=’is_empty’ width=’element_two_third’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Primary Physician Phone Number’ type=’text’ options=” check=’is_phone’ width=’element_third’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Vacation Bible Schools Release:’ type=’html’ options=” check=” width=” multi_select=” av_contact_preselect=”]
To the best of my knowledge, all registration and health information is correct.  Any images recorded while participating in camp activities may be used for the camp’s promotion free of any claims.  I give permission for my child to participate in all camp activities except as noted and agree that the camp or its staff will not be held responsible for any accidents or personal injury arising therefrom.  In the event of an emergency, I give permission to the medical personnel or staff selected by the camp to secure and/or administer any medical or emergency treatment, including hospitalization, deemed necessary for my child.  I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes.  I give permission to the camp to arrange necessary transportation for my child.  I understand that St. John’s Lutheran Church of Hatboro is not responsible for medical costs due to illness or injury while at this event, and I agree to cover all costs associated with any such injury.  I am the primary carrier of the accident/health insurance.  If all immunizations required for school are not up to- date, I understand and accept the risks to my child from not being fully immunized.
[/av_contact_field]
[av_contact_field label=’Parent Signature ( Full name or Initials Required)’ type=’text’ options=” check=’is_empty’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Date’ type=’datepicker’ options=” check=’is_empty’ width=’element_fourth’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’I would like to volunteer to teach, lead or help:’ type=’select’ options=’crafts,games,small group leader,science,sign-in table,snacks,large-group time,lesson preparation’ multi_select=’aviaTBaviaTBmulti_select’ check=” width=’element_half’ av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Photo Release: I permit my child’s photo to be used in displays in the church’ type=’select’ options=’Select One, Yes, No’ check=’is_empty’ width=’element_third’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Photo Release: In the church’s weekly and monthly newsletters and on the website’ type=’select’ options=’Select One, Yes, No’ check=’is_empty’ width=’element_third’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Photo Release: My child’s first and last name may be used.’ type=’select’ options=’Select One, Yes, No’ check=’is_empty’ width=’element_third’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Medical Release’ type=’html’ options=” check=” width=” multi_select=” av_contact_preselect=”]
In case of a medical emergency, I give my consent for my child to be transported to the nearest hospital, and for the attending physician to administer any necessary medical treatment.  I give St. John’s education staff permission to administer basic first aid (band-aids, etc) to my child.  Please note: The education staff will not administer any medication without written consent form the child’s parent on the day the medication is to be administered.  Whenever possible, please give your child any needed medications before bringing him/her to class.

If your child has been issued an Epi-pen, please note this under Special Needs on the registration form.
[/av_contact_field]
[av_contact_field label=’Parent Signature: (Full name or Initial required)’ type=’text’ options=” check=’is_empty’ width=’element_two_third’ multi_select=” av_contact_preselect=”][/av_contact_field]
[av_contact_field label=’Date:’ type=’datepicker’ options=” check=’is_empty’ width=’element_third’ multi_select=” av_contact_preselect=”][/av_contact_field]
[/av_contact]

[/av_section]