Register for Messiah Lutheran Christmas VBS 2019
If more than 3 children are attending, please fill out more than one online form, or call 715-834-2865. You may also email to this address: church.office@ecmessiah.org

If transportation is an issue, we'll try to help. Call Pastor Naumann 715-864-3465.
Parent First and Last Name *
Your answer
Address *
Your answer
Phone number *
Your answer
Email Address
Your answer
FIRST Child's Name *
Your answer
FIRST Child's Age *
FIRST Child's Grade Level *
Allergies to Food, Medications, Insects, Plants, Other? *
If yes, list allergies/explain:
Your answer
Primary Emergency Contact Name *
Your answer
Primary Emergency Contact Phone *
Your answer
Secondary Emergency Contact Name *
Your answer
Secondary Emergency Contact Phone *
Your answer
I authorize the Vacation Bible School staff at Messiah Lutheran Church to administer minor medical treatment (for example, minor cuts and scrapes) to my child(ren) while my child is under the staff's care at Vacation Bible School. This release applies to ALL children registered on this form. *
Your answer
Signature of Parent/Guardian *
Your answer
Date *
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If I or the previously designated guardian cannot be contacted, I authorize emergency medical treatment to be administered by trained medical personnel (for example, first responders, hospital emergency room staff) in case of my child's severe illness or injury. This release applies to ALL children registered on this form. *
Your answer
Name of Parent/Guardian (as signature) *
Your answer
Date *
MM
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DD
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YYYY
How did you hear about our VBS? *
(If registering only 1 child, scroll to the bottom and click "submit")
Your answer
SECOND Child's Name (optional)
Your answer
SECOND Child's Age
SECOND Child's Grade Level (coming school year)
Allergies to Food, Medications, Insects, Plants, Other?
If yes, list allergies/explain:
Your answer
THIRD Child's Name (optional)
Your answer
THIRD Child's Age
THIRD Child's Grade Level (coming school year)
Allergies to Food, Medications, Insects, Plants, Other?
If yes, list allergies/explain:
Your answer
Allergies to Food, Medications, Insects, Plants, Other?
Submit
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