2025 VBS REGISTRATION FORM

VBS REGISTRATION FORM
Child's Name
Street address
City
State
ZIP
Parent/Guardian Name(s)
Telephone
Format: (000) 000-0000.
Parent e mail address
example@example.com
Age
Date of birth

MonthDayYear
Date
Grade last completed
Child SmallChild MediumChild LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
In case of emergency, contact (name)
In case of emergency, contact (phone)
Format: (000) 000-0000.
Allergies or other medical conditions
Name of a special friend your child might like to be with
YesNo
YesNo
YesNo
Dated

MonthDayYear
Date
Signature

Clear
Full Name
Relationship
Registration Fee: $20.00 per child (includes t-shirt) Please make checks payable to Redeemer Lutheran Church *Please note if cost is a factor, please contact the Church Office as scholarships are available. We want all children to have the opportunity to attend*
Should be Empty: