Christ Lutheran Church Vacation Bible School: River of Life
Registration Form July 15-18 9:30 am to 10:45 am
Child's name
First Name
Last Name
Child's date of birth
Child's age
Child's last school grade completed
Parent/Family/Guardian Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email address
example@example.com
Phone numbers: Primary parent/caregiver cell phone
Please enter a valid phone number.
Phone numbers: Secondary parent/caregiver cell phone
Please enter a valid phone number.
Home church (if any)
Friends of your child at this church
Special needs/Allergies/Medical Information/Other
Emergency Contact 1 Name
Emergency Contact 1 phone number
Please enter a valid phone number.
Emergency Contact 2 Name
Emergency Contact 2 phone number
Please enter a valid phone number.
Name(s) of person(s) who may pick up this child from VBS
Photo Release: Christ Lutheran Church/VBS has my permission to use my child's photograph publicly in Christ Lutheran VBS materials. I understand the images may be used in print, online, websites and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Submit
Should be Empty: