VBS Registration Form

St. Luke's Church - VBS Registration From

July 26-30, 2026 from 5:30 p.m. to 7:30 p.m. (Ages 4-11)
- Child's Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
- Age
- Child's Last Grade Completed
- Child's Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
- Age
- Child's Last Grade Completed
- Child's Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
- Age
- Child's Last Grade Completed
- Parent/Guardian Name
  
  First NameLast Name
- Parent Cell Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Parent Email
  example@example.com
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Emergency Contact Name
  
  First NameLast Name
- Relationship
- Cell Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Child(ren) have any food allergies? If so, list children and allergies in next section.
- Please explain and give details.
- St. Luke's Church and VBS leaders have permission to photograph/film the minor designated above in any manner or form for any lawful purpose associated with promoting St. Luke's VBS program.
- Type name if agree to the above.
  Name of Person Submitting Registration
- Date
  
  MonthDayYear
  Date
- Should be Empty:

St. Luke's Church - VBS Registration From