Safari with God VBS registration
July 17-20, 2017
9am - noon
St. Martin Lutheran Church
813 Bay Rd. Webster, NY 14580
Contact us: 585-671-1899 (office) or Sharon Haffen 585-703-1441
Email address *
Name *
Your answer
Grade (September 2017) *
Youth Shirt Size *
Parent/Guardian Name(s) *
Your answer
Mailing Address *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Person Responsible for Pickup *
Your answer
Person Responsible for Pickup Phone *
Your answer
Allergies or special considerations
Your answer
Church Affiliation (if any)
Your answer
How did you hear about VBS? *
Your answer
Waiver *
I understand any pictures taken at VBS may be used in print or digital media to advertise our church’s programs. Please contact the church if you would prefer images of your child not be used for these purposes
Required
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