Good Shepherd Lutheran Church Vacation Bible School Registration Form

Parent Information

Parent First Name *

Parent Last Name *

What is your home church? *

Does your child attend Sunday School? *

Street Address *

City *

State *

Zip Code *

Parent Cell *

Home Phone *

Parent email: *

Child #1's First Name *

Child #1's Last Name *

Child #1's Age as of July 1 *

Child #1's Grade as of Sept *

Child #1's DOB * +

Child #2's First Name

Child #2's Last Name

Child #2's Age as of July 1

Child #2's Grade as of Sept

Child #2's DOB +

Child #3's First Name

Child #3's Last Name

Child #3's Age as of July 1

Child #3's Grade as of Sept

Child #3's DOB +

Child #4's First Name

Child #4's Last Name

Child #4's Age as of July 1

Child #4's Grade as of Sept

Child #4's DOB +

Emergency Contact Name *

Emergency Contact Phone *

Please list all allergies and any other medical information that the supervisors should know

Please list any other information that you think the supervisors should know

Click on the number of children you are registering on this form: *

1 Child ($25)

2 Children ($50)

3 Children ($75)

4 Children ($100)