VBS Registration

Trinity Evanglical Lutheran Church - Vacation Bible School Registration
800 N. Sumner, Creston, IA 50801
641-782-5095
Parent's Name

First NameLast Name
Child's Name

First NameLast Name
Child's Grade Next Fall:
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Parent's eMail
In Case of Emergency Notify:
Allergies
If so, what?
Family Physician:
Physican's Phone Number

Area CodePhone Number
Any Restrictions to Physical Activities?
Explain Activity Restrictions
Any Special Concerns?
Enter Code:
Should be Empty: