2018 Trinity Lutheran Church Vacation Bible School Registration
Event Name: God's FunLand VBS
Event Timing: July 9th-12th, 2018 6:00-8:15pm
Event Address: Trinity Lutheran Church, 47 W. Main Street, Mount Joy PA
Contact us at (717)653-4168

Child #1 (Last, First) Name: *
Your answer
Child #1 Age on July 9, 2018: *
Your answer
Child #1 Grade Just Completed (check "preschool" if not yet in school): *
Required
Child #1 Dietary or Physical Restrictions, Allergies, Medications, etc. Please list and be specific or write none. *
Your answer
Child #1 Name of a special friend your child might like to be with for the week: (If you are visiting from another church and would like your child paired with a friend at TLC, please list his/her name and grade.) *
Your answer
(If applicable-otherwise scroll to bottom for required questions) Child #2 (Last, First) Name:
Your answer
Child #2 Age on July 9, 2018:
Your answer
Child #2 Grade Just Completed (check "preschool" if not yet in school):
Child #2 Dietary or Physical Restrictions, Allergies, Medications, etc. Please list and be specific or write none.
Your answer
Child #2 Name of a special friend your child might like to be with for the week: (If you are visiting from another church and would like your child paired with a friend at TLC, please list his/her name and grade.)
Your answer
(If applicable-otherwise scroll to bottom for required questions) Child #3 (Last, First) Name:
Your answer
Child #3 Age on July 9, 2018:
Your answer
Child #3 Grade Just Completed (check "preschool" if not yet in school):
Child #3 Dietary or Physical Restrictions, Allergies, Medications, etc. Please list and be specific or write none.
Your answer
Child #3 Name of a special friend your child might like to be with for the week: (If you are visiting from another church and would like your child paired with a friend at TLC, please list his/her name and grade.)
Your answer
(If applicable-otherwise scroll to bottom for required questions) Child #4 (Last, First) Name:
Your answer
Child #4 Age on July 9, 2018:
Your answer
Child #4 Grade Just Completed (check "preschool" if not yet in school):
Child #4 Dietary or Physical Restrictions, Allergies, Medications, etc. Please list and be specific or write none.
Your answer
Child #4 Name of a special friend your child might like to be with for the week: (If you are visiting from another church and would like your child paired with a friend at TLC, please list his/her name and grade.)
Your answer
Parent/Guardian (Last, First) Names: *
Your answer
Parent/Guardian Cell Phone Numbers: *
Your answer
Parent/Guardian Email Address: *
Your answer
Mailing Address: *
Your answer
Emergency Contact (Full Name, Relationship, Cell Phone Number): *
Your answer
Medical Permission - My child has/children have my permission to participate in youth events at Trinity Lutheran Church, Mount Joy PA. In the event that I can not be found, permission is given to have treatment in a medical facility as deemed necessary. *
Photo Permission - We at Trinity Lutheran Church occasionally use the photographs of children and youth for websites, newsletters, and other in-house publications. It is our practice to not list the name of the child or youth with the photograph. *
The undersigned does hereby agree to hold harmless, release, remiss, acquit and forever discharge Trinity Lutheran Church, its staff, employees, volunteers, agents, successors and assigns, of and from all claims, demands, causes of action, obligations, rights, damages, losses, expenses, costs, rejoinders or controversies arising out of my child’s/my children's participation in any program or any activities with Trinity Lutheran Church. *
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