Vacation Bible School @ Martin Luther Lutheran Church Registration
We can't wait to blast off with you on July 25th! Please complete all sections below. If you are registering more than one child, you will be prompted to add their information at the form's end.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Grade Entering (Upcoming School Year)
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Other
Medical Conditions or Allergies
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Photo/Media Release Permission
*
Yes, I give permission for my child to be photographed/recorded
No, I do not give permission
Medical Treatment Consent
*
Yes, I consent to emergency medical treatment for my child if necessary
No, I do not consent
Any additional adult authorized to pick up child?
Shirt Size
Please Select
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Save
Register
Should be Empty: