2017 Good Shepherd and St. Mary Vacation Bible School Registration
Monday, June 12th - Friday, June 16, 2017 from 9:00am - 12:00pm

AT GOOD SHEPHERD: N88 W17658 Christman Rd. Menomonee Falls 53051

REGISTRATION IS CLOSED. VBS is FULL!

Child 1 First and Last Name
Your answer
Child 1 Grade (Fall 2017)
Child 2 First and Last Name
Your answer
Child 2 Grade (Fall 2017)
Child 3 First and Last Name
Your answer
Child 3 Grade (Fall 2017)
Child 4 First and Last Name
Your answer
Child 4 Grade (Fall 2017)
Parish or Friend Of *
Your answer
Optional: Would you like a music CD or digital download for an extra $8?
PARENT/GUARDIAN FULL NAME *
Your answer
HOME ADDRESS *
Your answer
PRIMARY EMAIL ADDRESS *
Your answer
ALTERNATE EMAIL ADDRESS
Your answer
BEST PHONE TO CONTACT DURING EVENT *
Your answer
ALTERNATE PHONE
Your answer
ALTERNATIVE CONTACT (If unable to reach you) *
Your answer
ALTERNATIVE CONTACT BEST PHONE DURING EVENT *
Your answer
PHYSICIAN'S FULL NAME *
Your answer
PHYSICIAN'S PHONE *
Your answer
NAME OF MEDICAL INSURANCE *
Your answer
MEDICAL INSURANCE POLICY NUMBER *
Your answer
PERTINENT MEDICAL CONDITIONS
Your answer
INHALER/EPI-PEN
ANY FOOD ALLERGIES TO BE AWARE OF?
Your answer
Youth Volunteer 1 - Name
Your answer
Youth Volunteer 1 Grade (Fall 2017)
Youth Volunteer 1 Email
Your answer
Youth Volunteer 1 - Days Available
Youth Volunteer 2 - Name
Your answer
Youth Volunteer 2 Grade (Fall 2017)
Youth Volunteer 2 Email
Your answer
Youth Volunteer 2 - Days Available
Adult Volunteer Name
Your answer
Adult Volunteer Email
Your answer
Adult Volunteer days available
Do you need child care for children under 4 (adult volunteers only)?
If so, how many children and what age(s) are the children?
Your answer
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