VBS Registration – June 10th-14th

Child's Name*
First Last
Gender*
Age (3 and potty trained- entering 6th grade)*
Grade Completed*
Medical Issues/ Allergies
Parent Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Parent Email*
Parent Cell Phone*
Parent Home Phone
Home Church*
Enter information for a second child if applicable
Child's Name
First Last
Gender
Age (3 and potty trained-entering 6th grade)
Grade Completed
Medical Issues/ Allergies
Enter information for a third child if applicable
Child's Name
First Last
Gender
Age (3 and potty trained-entering 6th grade)
Grade Completed
Medical Issues/ Allergies
May Peace Lutheran use photos or videos with the image of your child(ren) in a legal way for promotion and advertisement?*
- Yes
- No