Rainforest Falls VBS

VBS Registration Form

One Per Child
Zion Lutheran Church

4447 Central Ave

Gasport, NY 14067

August 10th - 14th, 2026

9:00 am - 12 Noon

Cost: Free

Questions: Contact Kim or Melissa

Email: zionlutherangasportvbs@gmail.com Call/Text: 716.266.2982
Child's Information
Child's Name

Child's First NameChild's Last Name
Child's Gender
Child's Age
ex. 5 years
Child's Birthdate

MonthDayYear
Date
Last School Grade Finished
ex. 6th Grade
Parent/Guardian Information
Name of Parent/Guardian 1

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Parent/Guardian 2

First NameLast Name
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Caregiver's Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Email Address
example@example.com
Home Church
ex. Zion Lutheran Church
Medical and Emergency Information
Allergies, Medical Conditions, or Special Needs
If not applicable, please type N/A
In Case of Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Miscellaneous
Days Child Will Be Attending
Do we have permission to take your child's photo? Photos may be used on social media.
Should be Empty:

VBS Registration Form