VBS 2022 Form

LTHC Vacation Bible School

June 20-24, 2022 • 5:30pm - 8:15pm Nightly
Registration Form

Please fill out and complete form
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Please select your child’s age group below:
Parent Name

First Name Last Name
Mobile Number
Emergency Contact

First Name Last Name
Phone Number
Place below any medical issues we need to be aware of
Signature

Clear
Should be Empty: