2023 STELLAR!VBS Registration FormAge 4 through 6th Grade.August 6th - 10th6:00pm - 8:30pmChurch of St. Luke, Clearwater, MN.ONE FORM NEEDED FOR EACH PARTICIPANT Name:* Birthdate (mm/dd/yyyy):* Gender:*Select valueMaleFemale Age:* Address:* Street Address Street Address Line 2 City Postal / Zip Code Home Phone Number:* Area Code - Phone Number Parent(s) Name(s):* Parent Cell Phone:* Area Code - Phone Number E-mail:* In case of emergency & I can't be reached, contact:* Emergency Contact Phone:* Area Code - Phone Number Allergies or other Medical Conditions we should know about: School grade your child is entering this Fall:* Name of home parish/church:* I hereby GRANT permission for my child (name) To attend STELLAR Shine Jesus's Light! VBS at St. Luke on August 6th - 10th, 2023:Select valueYes I hereby GRANT/DO NOT GRANT (select one) permission for St. Luke to use the image of my child at VBS on St. Luke publications, either printed or electronic:Select valueGRANTDO NOT GRANT Parent / Guardian printed name: Today's Date (mm/dd/yyyy):* SubmitReset