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Please
sign up once for each child.
Transportation needed?
Yes, I
need a ride.
No, I
don't need transportation.
Name:
Grade Completed:
Birthday:
Age:
Parents' Names:
Street Address:
City:
State:
Zip:
Phone:
Alt. Phone:
E-mail:
Emergency Contact Person:
Relationship to Student:
Home Phone:
Alt Phone:
Family Doctor:
Phone:
Allergies or other medical problems:
Siblings attending VBS (Names &
Ages):
Church
Affiliation (Lutheran, Catholic, etc.):
Church membership
at:
Brought by:
I give permission for my child's photo (not name) to be used in promotional materials.
Comments:
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