Mount Calvary Lutheran | Holdrege, Nebraska

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2020 VBS Registration

Father's Name
First Last
Mother's Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Cell Phone Number (Father)
Daytime Phone Number (Father)
Cell Phone Number (Mother)
Daytime Phone Number (Mother)
Parents' Email
Alternate Pickup Contact
Name of Pickup Contact (If different from parents listed above)
First Last
Home Phone Number (Pickup Contact)
Cell Phone Number (Pickup Contact)
Child 1 - Registration & Medical Information
Child's Name
First Last
Age
Year In School (2020/2021)
Gender
- Male
- Female
Allergies
- Pollens
- Medications
- Food
- Insect Bites
- Other
Elaborate on Possible Allergies
Has this child suffered from, experienced, or is being treated for:
- Asthma
- Heart Trouble
- Frequently Upset Stomach
- Epilepsy/Seizure Disorder
- Diabetes
- Physical Handicap
Please Elaborate
Has the child had any major illnesses in the past year? If so, should the child's activities be restricted in any way?
Child 2 - Registration & Medical Information
Child's Name
First Last
Age
Year In School (2020/2021)
Gender
- Male
- Female
Allergies
- Pollens
- Medications
- Food
- Insect Bites
- Other
Elaborate on Possible Allergies
Has this child suffered from, experienced, or is being treated for:
- Asthma
- Heart Trouble
- Frequently Upset Stomach
- Epilepsy/Seizure Disorder
- Diabetes
- Physical Handicap
Please Elaborate
Has the child had any major illnesses in the past year? If so, should the child's activities be restricted in any way?
Child 3 - Registration & Medical Information
Child's Name
First Last
Age
Year In School (2020/2021)
Gender
- Male
- Female
Allergies
- Pollens
- Medications
- Food
- Insect Bites
- Other
Elaborate on Possible Allergies
Has this child suffered from, experienced, or is being treated for:
- Asthma
- Heart Trouble
- Frequently Upset Stomach
- Epilepsy/Seizure Disorder
- Diabetes
- Physical Handicap
Please Elaborate
Has the child had any major illnesses in the past year? If so, should the child's activities be restricted in any way?
Photo Release
I hereby grant Mt. Calvary Church permission to use photographs/videos taken of the minor(s) designated above in any manner or form for any purpose lawful at any time.
- Yes
- No
COVID-19
To ensure safety of everyone we ask that those entering our facility are free of the following symptoms that are related to the COVID-19 virus: Fever, Chills, Cough, Shortnes of breath, Muscle aches, Sore throat, New loss of sense of smell and taste. We ask you to maintian proper social distancing from others, wash hands, use hand sanitizer, and cover your mouth and nose when sneezing or coughing. An inherent risk of exposure to COVID-19 exists where people are present. By signing I understand that I voluntarily assume all risks related to exposure to COVID-19.
Medical Release
Medical Release I give my permission for VBS staff to administer basic first aid to my child(ren) (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.
Permission to Attend
Permission to Attend I give permission for my child(ren) (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church.
Signing Parent/Guardian
First Last
Date
MM slash DD slash YYYY

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Prayer Request

Prayer is talking to, asking, and honoring God. The Bible says that God listens to those who pray to Him and we would love to pray for you. Please call the church office at 308-995-2208 to request prayer.

News & Recent Updates

Backpack Blessing Pack
Prayer Event
Movie Matinee
Ministry Appreciation Month
Child Care

Services & Events

Location & Contact

Mount Calvary Lutheran Church

1419 East Avenue
Holdrege, Nebraska 68949

Phone: 3089952208

Our Mission

"Bringing the Good News of Jesus to all people for the first time and a lifetime."

Affiliation

Mount Calvary is a member congregation of The Lutheran Church Missouri Synod.

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