Zion Lutheran Church 2021 VBS Participant Registration
Please fill out all required information. A separate registration form is needed for EACH participant. All children age 3 through completion of 5th grade are welcome to attend! VBS dates: Monday, June 28th - Friday, July 2nd; 9:00 a.m. to 11:45 a.m. Closing program followed by ice cream social on Friday, July 2nd at 11:45 a.m. Your child must be 3 years old by June 28th and be potty-trained to attend VBS.
Child's First Name *
Child's Last Name *
Parent's Name (First and Last) *
Mailing Address (Number, Street, City and Zip Code) *
Child's Date of Birth - Child must be 3 years old by June 28th (1st day of VBS) and MUST be potty-trained. *
School grade just COMPLETED *
Home Phone (Include Area Code) *
Cell Phone (Include Area Code) *
Email Address - All communications will be done through email. Please make sure your email address is correct. *
Emergency Contact Name (First and Last Name) *
Emergency Contact Phone Number (Include Area Code) *
Alternate Pick-up Name and Phone Number - Please enter the name of a person (other than yourself) who is authorized to pick-up your child and their phone number. Be sure to include the area code. *
Allergies - Please check the appropriate box for any allergies your child may have. *
Will you send in medication for allergies? Parents must supply all medications with the child's name written on the container. Written instructions for all medications need to be included. Please give all medications to our Director, Melanie Hodges on the first day of VBS. *
Photo Release - We will take pictures of the children during VBS. Photos will be placed on the bulletin boards inside the entry to the CEB and pictures may also be used for our church website. The child's name will NOT appear with the picture. By selecting "yes" to the above, you will be giving us permission to take pictures of your child. *
We will be providing VBS take home music via a download platform. Are you interested in receiving the instructions to download the music? *
Will you and your family be joining us for our closing program? *
If joining us for the closing program, how many will attend (including your child)? *
Home Church *
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