2026 Grace Lutheran VBS Registration

2026 Grace VBS Registration

Just like Me Aug. 10- 14, 2026
Camper's Information
Camper Name
Nickname
Date of Birth

MonthDayYear
Date
Age as of Camp date (Aug. 10, 2026)
Entering Grade in Fall
T-Shirt Size
NOTE - This program is prepared for children 3 - 11 years old, and are potty-trained. Younger children may be welcome after discussion with the coordinator if they are considered ready to participate with the older kids.

Please contact the office at office@grace97330.org to set up a discussion of a younger child's readiness.
Home Church (if you have one)
Age

Parents' Information

Parent/Guardian 1
Parent/Guardian 1

First NameLast Name
Relationship to Child
E-mail
Primary Phone
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Format: (000) 000-0000.
Parent/Guardian 2

First NameLast Name
Parent/Guardian 2
Relationship to Child
Primary Phone
Format: (000) 000-0000.
E-mail
Secondary Phone
Format: (000) 000-0000.
Home Address Same as Parent/Guardian 1?
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Format: (000) 000-0000.

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you.
In case of emergency, please notify:

Emergency Contact #1
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Format: (000) 000-0000.
Relationship to Child
Transportation-Approved Drivers

list anyone authorized to pick up camper
Additional Driver#1 Full Name

First NameLast Name
Driver's Phone Number
Format: (000) 000-0000.
Relationship to Child
Additional Driver#2 Full Name

First NameLast Name
Driver2's Phone Number
Format: (000) 000-0000.
Relationship to Child
Driver 3 Full Name

First NameLast Name
Additional Driver#3 Phone Number
Format: (000) 000-0000.
Relationship to Child
Driver 4 Full Name

First NameLast Name
Driver 4's Phone Number
Format: (000) 000-0000.
Relationship to Child
Does your child have permission to walk or bike home after camp?

Permissions
I hereby give informed and expressed consent for my child to take part in all VBS activities under supervision, and agree that the program personnel will not be held responsible for accidents arising there. I authorize the VBS healthcare provider and/or designated VBS staff/volunteer to provide appropriate treatment to my child for injuries and/or illness. I understand that the information on this form may be released to the appropriate medical personnel in case of medical emergency. I also understand the failure to disclose medical or emotional problems in advance may lead to serious consequences while at VBS. Lastly, I verify that everything contained on this form is complete and accurate, to the best of my knowledge.
Type first and last name above to consent
I also consent to the use of any photograph of my child or family in future Grace Lutheran publications.
Type first and last name above to consent
Sign Document
Date Signed

MonthDayYear
Camp Director Name and Contact Info
Payment
Thank you for registering your child for Day Camp!

Suggested registration is $20/camper and $15/+child in a family, with a $50 family maximum.

We want this experience to be available to all families regardless of circumstances. If your child needs a campership to attend, please enter the amount you can contribute and complete the card information to Submit the form.
How would you like to contribute to registration?

Other
Please check box if you would like to discuss a campership
Should be Empty:

Rows	Mild	Moderate (Swelling or severe rash)	Severe (Difficulty Breathing)
Food
Medication
Environmental (animal, plant, insect, etc…)
Other

2026 Grace VBS Registration

Camper's Information

Parents' Information

Emergency Contacts/Authorized Pickup

In case of emergency, please notify:

Transportation-Approved Drivers

Medical / Health Information

Additional Medication

Permissions

Payment