2019 VBS Registration
Messiah Lutheran Church
Vacation Bible School
Registration Form

Monday, July 15th-Wednesday, July 17th
Monday & Tuesday at Messiah. Wednesday at Cole Park
5:30-8:30pm Family Supper at 5:30pm

Child's name *
Your answer
Child's Age *
Your answer
Date of Birth *
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DD
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Last School Grade Completed *
Your answer
Name of Parent/Guardian: *
Your answer
Street Address (include PO Box) *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Telephone *
Your answer
Parent/Caregiver's Cell Phone *
Your answer
Email Address *
Your answer
Allergies or other medical conditions *
Your answer
In case of emergency, contact *
Your answer
Phone *
Your answer
Relationship to Child *
Your answer
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