Vacation Bible School

Child's Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade in Fall
Allergies or medical conditions:
Baptized?
Attended Last Year?
Days attending:
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
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
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Children may be released to:
Please list any persons who may be picking up your children
I, First Name* Last Name* , authorize, in case of an EMERGENCY, that Our Redeemer Lutheran Church can give First Aid or that my child can have Emergency Medical Treatment.
Signature (indicates permission given)
How did you hear about VBS?
Home Church:
Please list any special needs or additional information
Should be Empty: