VBS Registration Form
June 24 – June 27, 2024 | 9:00 am – 12:00 pm
Student's Full Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Student's Age
*
3
4
5
6
7
8
9
10
11
12
Student's Gender
*
Male
Female
Last School Grade Completed
*
Daycare
PK3
PK4
Kindergarten
1st
2nd
3rd
4th
5th
T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Allergies or other medical conditions
*
Parent / Guardian Information
Parent / Guardian Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Zip Code
Phone Number
*
Email
*
example@example.com
Relationship to Child
*
Authorized Pickup Persons
Pick up person authorization
*
I would like to allow someone else to pick up my child from VBS
I DO NOT allow anyone other than myself to pick up my child from VBS
Full Name
*
First Name
Last Name
Phone Number
*
Relationship to Child
*
Full Name (Optional)
First Name
Last Name
Phone Number
Relationship to Child
Authorization
Signature Authorization
Submit
Our Savior Lutheran Church | 3003 Horizon Road Rockwall, Texas 75032 | 972-771-8118
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