New Customer Registration Form

VBS Kid's Camp Registration

Please fill out one form for each child
Full Name of child*

First NameLast Name
Grade that the child is going into:
Birthdate*

MonthDayYear
Date
Please list any allergies or conditions that we should be aware of.
Parent's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number*
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Photo Release:

I hereby give Hills of Peace Lutheran Church permission to take photographs of my child, or photographs in which they might be involved with others, for the sole purpose of promoting the ministry of Hills of Peace Lutheran Church. I understand that these photos may be posted on Hills of Peace Lutheran Church website or social media.
I prefer that my child's first name only be used when identifying those in the photo(s).I prefer that my child's name not be used when identifying those in the photo(s).I prefer that photo(s) of my child NOT be posted on the Hills of Peace Lutheran Church website or social media.
Signature
Should be Empty:

VBS Kid's Camp Registration