You are registering for Vacation Bible School 2019

Registration Form created by Sigrid Hipkiss

Blast off with VBS! At "To Mars and Beyond" VBS, kids age 3 through grade 5 will discover the wonders of God's universe and will be inspired to give glory to God, who is able to do far beyond all that we could ask or imagine! Come for the fun Monday, July 8 to Friday, July 12 from 6:15-8:30PM at Trindle Spring Lutheran Church. Supper will be served every night beginning at 5:30PM. Contact de66smith@gmail.com with any questions.

Child's Name*

Age (must be 3 years old by July 8)*

Date of Birth*

Grade Completed by July*

Parent/ Guardian Name(s)*

Street Address*

Town*

State*

Zip code*

Primary Phone Number*

Alternate Phone Number*

Email Address*

Please re-enter the Email Address*

Send me a confirmation email (recommended)

Emergency Contact*

Emergency Contact's Phone Number*

Emergency Contact's Relationship to Child*

Person(s) OTHER than the parent/ guardian who may pick up your child

Relationship to Child

Does your child have any food allergies?*

If yes, please list food allergies

Other allergies or medical concerns?

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