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VBS Registration 2026
Salem Lutheran Church
1724 15th St. Moline, IL 61265
309-764-5614
July 20th-24th
9am-Noon
Ages 3-7th grade
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Email
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Your email
Child's Name
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Child's Age
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Child's Birthday
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DD
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Grade Entering
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Name of Parent(s)
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Street Address
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City, State, Zip
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Telephone Number
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In case of Emergency Contact:
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Relationship to Child
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Allergies or other Medical Conditions
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Home church
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Permission is Granted for Salem Lutheran Church to use photographic or digital images of my child in Salem Publications/newsletter
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