2018 Community VBS Registration
Location: First Lutheran Church of Prophetstown
Date: July 23-27 2018
Time: 5:30-8:00pm
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Child's Age *
Your answer
Child's Date of Birth *
Your answer
Last school grade completed *
Name of parents *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone *
Your answer
Parent/caregiver's cell phone *
Your answer
Home email address *
Your answer
Home Church (include church name and town) *
Your answer
Allergies/Medical conditions *
Your answer
In case of Emergency: List name, phone, and relationship to child *
Your answer
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