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*

YesNo
If so, what?
Family Physician:*
Physican's Phone Number*

Area CodePhone Number
Any Restrictions to Physical Activities?

YesNo
Explain Activity Restrictions
Any Special Concerns?
Enter Code:*
Should be Empty: