VBS 2019: River of Life Registration Form Light of Christ Lutheran Church & St. Paul's Lutheran Church of Irvine
June 24-28 9 AM to 12 Noon
We Welcome Children In -Preschool thru 4th Grade
Registration Deadline: JUNE 3RD (Only 75 spots available -Register Today!) Please submit one form for each child attending VBS
Child Information
Child's Name: *
Your answer
Child's Age: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Last School Grade Completed: *
Siblings Attending VBS (names & ages):
Your answer
Select Days Attending: *
Required
Parent/Caregiver Information
Name of Parents/Caregiver: *
Your answer
Home Address: *
Your answer
Home Phone:
Your answer
Cell Phone:
Your answer
Medical Information
Family Doctor: *
Your answer
Doctor's Phone: *
Your answer
Medical Concerns/Allergies:
Your answer
Current Medications:
Your answer
Food Allergies
Please note that if your child has any food allergies, we request that you bring a snack from home for him/her to enjoy each day. The snack should be clearly labeled with the child’s full name and brought to the kitchen located through the Church's Fellowship Hall.
Please List Food Allergies:
Your answer
Other Emergency Contacts
List Name, Relationship to Child, and Phone Number:
Your answer
People Who May Pick Up the Child
List Name & Relationship to the Child: *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service