VBS Registration

VBS Registration Form

One Per Child
Zion Lutheran Church

4447 Central Ave

Gasport, NY 14067

August 12th - August 16th, 2024

9:00 am - 12 Noon

Cost: Free

Questions: Contact Kim or Melissa

Email: zionlutherangasportvbs@gmail.com Call/Text: 716.772.8062
Child's Information
Child's Name*

Child's First NameChild's Last Name
Child's Gender

FemaleMaleChoose not to disclose
Child's Age*
ex. 5 years
Child's Birthdate*

MonthDayYear
Date
Last School Grade Finished*
ex. 6th Grade
Parent/Guardian Information
Name of Parent/Guardian 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Parent/Guardian 2

First NameLast Name
Home Phone Number*
Please enter a valid phone number.
Parent/Caregiver's Cell Phone Number
Please enter a valid phone number.
Home Email Address
example@example.com
Home Church
ex. Zion Lutheran Church
Medical and Emergency Information
Allergies, Medical Conditions, or Special Needs*
If not applicable, please type N/A
In Case of Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship to Child*
Miscellaneous
Days Child Will Be Attending*

Monday, August 12, 2024Tuesday, August 13, 2024Wednesday, August 14, 2024Thursday, August 15, 2024Friday, August 16, 2024
Do we have permission to take your child's photo? Photos may be used on social media.*

YesNo
Should be Empty:

VBS Registration Form