VBS Registration Form- Mandarin Lutheran Church

DATE : June 24th – June 28th

TIME : 5:00 pm – 8:00pm

$25 for Registration

$20 for an additional child
VBS Registration Form

Please fill the form below and let us know if you give go ahead for this child's participation
- Participant Name
  
  First NameLast Name
- Boy or Girl?
- T-shirt Size
- Date of Birth
  
  MonthDayYear
- Grade
- Medical Problems/ Allergies / Special Needs
- Parent / Guardian's Name
  
  First NameLast Name
- Phone Number
  
  Area CodePhone Number
- Parent / Guardian's Name
  
  First NameLast Name
- Phone Number
  
  Area CodePhone Number
- E-mail
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip CodeCountry
- Emergency Contact Name
  
  First NameLast Name
- Phone Number
  
  Area CodePhone Number
- E-mail
  example@example.com
- Authorized Pickup Name
  
  First NameLast Name
- Authorized Pickup Name
  
  First NameLast Name
- Do you currently have a home church?
- If Yes, where?
- Tell us how you learned about VBS at MLC :
  
  Other
- I understand that I will be notified in the case of a medical emergency involving my child. In the event that neither I nor the above listed emergency contact can be reached, I authorize MLC to arrange for a doctor and the providing of necessary medical services as deemed necessary to protect the welfare of my child.
- Signature
- I consent to allow photos to be taken during VBS to be used in/on craft projects and church bulletin boards, including but not limited to church website/ Facebook page.
- Signature
- By signing and submitting this registraiton form, you understand and agree to all policies.
- Parent/Guardian Signature
  
  First NameLast Name
- Today's Date
  
  MonthDayYear
- Comments and/or Questions:
- Should be Empty: