Waterville VBS 2017
Registration Form

PLEASE FILL OUT A REGISTRATION FORM FOR EACH CHILD

Register online by Saturday, June 24 to win a Highway 2 Brew Gift Card!


June 26-30 (Monday-Friday)
9:00am-12:00pm each day
United Lutheran Church, Waterville

Email address *
Participant's First Name *
Your answer
Participant's Last Name *
Your answer
Participant's Gender *
Date of Birth *
MM
/
DD
/
YYYY
Last School Grade Completed *
Parent(s) Names *
Your answer
Parent Phone Number #1 *
Your answer
Parent Phone Number #2
Your answer
Email (needed for online registration) *
Your answer
Physical Address *
Your answer
Dietary Restrictions *
Allergies or other medical conditions *
Anything you'd like us to be aware of?
Your answer
Non-parent Emergency Contact Name *
Your answer
Non-parent Emergency Contact Phone Number *
Your answer
Non-parent Emergency Contact Relationship to Participant
Your answer
Submit
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