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: *
 

Student(s) Information

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 and Other Information

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)