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Registracion del Participante

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St. Lawrence Catholic Church

Location

44633 Utica Road

Utica, MI 48317

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Contact Lisa Rajnicek:

586-731-5072

lrajnicek@stlawrenceparish.com

Primero, cuéntenos sobre usted:

Información de los Padres

Nombre

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Apellido

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Correo Electrónico

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Dirección 1

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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Teléfono de Contacto 1

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Teléfono de Contacto 2

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In which format do you prefer to receive VBS music?

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Cuéntanos sobre tu participante

Nombre

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Apellido

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Grado Entrando

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Género

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Fecha de nacimiento

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Talla de Camisa

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Alergias

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Preocupaciones Médicas

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¿Tienes amigos con los que te gustaría estar juntos? Haremos todo lo posible para juntar a los amigos seleccionados en el mismo grupo, pero no podemos prometer que todas las solicitudes serán posibles.

Amigo 1 Nombre

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Amigo 1 Apellido

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Nombre del Contacto de Emergencia

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Emergency Contact: Phone number

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Emergency Contact: Relationship to participant

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Emergency Info: Family Physician Name

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Emergency Info: Family Physician Address & Phone

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Emergency Info: Health Insurance Company name

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Emergency Info: Health Insurance Policy - Name of Policy Holder (adult/guardian)

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Emergency Info: Health Insurance Policy Number (group and contract)

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AOD Medical Treatment Release for VBS 2025

Purpose: St Lawrence 2025 Vacation Bible School.
As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me. I further authorize the person who present the minor to sign the Acknowledgement of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is complete and signed of my own free will with the sole purpose of authorizing medical treatment deemed necessary and appropriate by the treating physician.

Electronic Signature Agreement

By entering my full legal name here, I am agreeing that this electronic signature indicates my agreement that: 1) I have received, read, and agreed to the terms of the Medical Release indicated above; and 2) I consent to the use of this electronic signature for the sole purpose of this Medical Release for St. Lawrence VBS 2025, July 14-18, 2025.

Medical Treatment Release for St Lawrence 2025 Vacation Bible School: Click "yes" to confirm you have read and agreed to this release.

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Enter parent/guardian full legal name here for Electronic Signature (agreed as above)

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