VBS Registration Form - Immanuel Lutheran, Perryville

VBS Registration Form

Please fill out the form below with your child/children's info.
Participant Name

First NameLast Name
Age
Grade: (grade just completed).
Participant Name

First NameLast Name
Age
Grade: (grade just completed).
Participant Name

First NameLast Name
Age
Grade: (grade just completed).
Participant Name

First NameLast Name
Age
Grade: (grade just completed).
Parent / Guardian's Name

First NameLast Name
Contact Phone Number

Area CodePhone Number
Medical Problems/ Allergies / Special Needs
I herby grant the VBS leaders permission to photgraph/film the minor(s) designated above in any manner or form for any lawful purpose associated with this VBS program.
By signing and submitting this registraiton form, you understand and agree to all policies.
Parent/Guardian Signature

First NameLast Name
Today's Date

MonthDayYear
Meals are provided for children and their families from 5pm-5:30pm each evening prior to VBS. Please type the day (Sunday-Thursday) & how many people will be eating an evening meal each day.
If you or your child is interested in volunteering please comment with name and desired group to assist.
Should be Empty: