Register for Messiah Lutheran VBS 2019
Registration is for June 10-14 or August 5-9, 2019.

If more than 4 children are attending, please fill out more than one online form, or call 715-834-2865. You may also email to this address: messiah.ec.secretary@gmail.com

The "Emergency Parental Contact/Medical Treatment Authorization" form has been included in the digital registration form below to save time on the first day of VBS.

If transportation is an issue, we'll try to help. Call Pastor Schaller 715-577-6199 (June session) or Pastor Naumann 715-864-3465 (August session).

Parent or Guardian (Last Name, First Name) *
Your answer
Full Address *
Your answer
Phone Number *
Your answer
Email Address
Your answer
Session Attending *
FIRST Child's Name *
Your answer
FIRST Child's Date of Birth
MM
/
DD
/
YYYY
FIRST Child's Age *
FIRST Child's Grade Level (coming school year) *
Allergies to Food, Medications, Insects, Plants, Other? *
If yes, list allergies/explain:
Your answer
Primary Emergency Contact Name *
Your answer
Primary Emergency Contact Phone *
Your answer
Secondary Emergency Contact Name *
Your answer
Secondary Emergency Contact Phone *
Your answer
I authorize the Vacation Bible School staff at Messiah Lutheran Church to administer minor medical treatment (for example, minor cuts and scrapes) to my child while my child is under the staff's care at Vacation Bible School.
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
If I or the previously designated guardian cannot be contacted, I authorize emergency medical treatment to be administered by trained medical personnel (for example, first responders, hospital emergency room staff) in case of my child's severe illness or injury.
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
SECOND Child's Name (optional)
Your answer
SECOND Child's Date of Birth
MM
/
DD
/
YYYY
SECOND Child's Age
SECOND Child's Grade Level (coming school year)
Allergies to Food, Medications, Insects, Plants, Other? *
If yes, list allergies/explain:
Your answer
Primary Emergency Contact Name *
Your answer
Primary Emergency Contact Phone *
Your answer
Secondary Emergency Contact Name *
Your answer
Secondary Emergency Contact Phone *
Your answer
I authorize the Vacation Bible School staff at Messiah Lutheran Church to administer minor medical treatment (for example, minor cuts and scrapes) to my child while my child is under the staff's care at Vacation Bible School.
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
If I or the previously designated guardian cannot be contacted, I authorize emergency medical treatment to be administered by trained medical personnel (for example, first responders, hospital emergency room staff) in case of my child's severe illness or injury.
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
THIRD Child's Name (optional)
Your answer
THIRD Child's Date of Birth
MM
/
DD
/
YYYY
THIRD Child's Age
THIRD Child's Grade Level (coming school year)
Allergies to Food, Medications, Insects, Plants, Other? *
If yes, list allergies/explain:
Your answer
Primary Emergency Contact Name *
Your answer
Primary Emergency Contact Phone *
Your answer
Secondary Emergency Contact Name *
Your answer
Secondary Emergency Contact Phone *
Your answer
I authorize the Vacation Bible School staff at Messiah Lutheran Church to administer minor medical treatment (for example, minor cuts and scrapes) to my child while my child is under the staff's care at Vacation Bible School.
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
If I or the previously designated guardian cannot be contacted, I authorize emergency medical treatment to be administered by trained medical personnel (for example, first responders, hospital emergency room staff) in case of my child's severe illness or injury.
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
FOURTH Child's Name (optional)
Your answer
FOURTH Child's Date of Birth
MM
/
DD
/
YYYY
FOURTH Child's Age
FOURTH Child's Grade Level (coming school year)
Allergies to Food, Medications, Insects, Plants, Other? *
If yes, list allergies/explain:
Your answer
Primary Emergency Contact Name *
Your answer
Primary Emergency Contact Phone *
Your answer
Secondary Emergency Contact Name *
Your answer
Secondary Emergency Contact Phone *
Your answer
I authorize the Vacation Bible School staff at Messiah Lutheran Church to administer minor medical treatment (for example, minor cuts and scrapes) to my child while my child is under the staff's care at Vacation Bible School.
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
If I or the previously designated guardian cannot be contacted, I authorize emergency medical treatment to be administered by trained medical personnel (for example, first responders, hospital emergency room staff) in case of my child's severe illness or injury.
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
How did you hear about our VBS? *
Submit
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