St. Peter's Evangelical Lutheran Church North Plato
Vacation Bible School Registration Form
Child's Name
First Name
Last Name
Child's Gender
Male
Female
Child's Date of Birth
Grade Child Will Enter This Fall
Preschool
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mother's Name
Mother's Email
example@example.com
Mother's Cell Number
Please enter a valid phone number.
Father's Name
Father's Email
example@example.com
Father's Cell Number
Please enter a valid phone number.
Child's Medical Needs and Allergies
Emergency Contacts (Name, Relationship to Child, & Cell Number)
Persons Authorized to Take My Child After VBS (Name & Cell Number)
May We Include Your Child(ren) in Photos for the Church's Website?
Yes
No
Signature
Continue
Continue
Should be Empty: