Zoar Lutheran Church Vacation Bible School Child Registration
Please complete a separate registration form for each child.
July 10th-14th, 2017 from 9:00 AM-Noon at 314 E. Indiana Ave.
Child's First and Last Name:
Your answer
Child's Grade for Fall 2017:
Your answer
Child's Date of Birth:
MM
/
DD
/
YYYY
Child's Current Age
Your answer
Child's Gender
Parent/Guardian(s) First and Last Name(s)
Your answer
Street Address (include City and State)
Your answer
Primary Phone Number
Your answer
Secondary Phone Number (if applicable)
Your answer
Email Address (if not applicable, type N/A)
Your answer
Home Church (if applicable)
Your answer
Child T-Shirt Size (free t-shirt if registered before June 1st)
Allergies or Medical Conditions:
Your answer
Educational/Accessibility Needs or Concerns:
Your answer
In case of emergency, please contact: (full name and relationship to child, ex. Carla Ramirez, aunt)
Your answer
Emergency Contact Phone Number(s):
Your answer
Would you be interested in helping with Vacation Bible School?
Thank you for registering! If you have any questions regarding VBS, please contact Madeline at mthomas@zoarlutheran.com
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