Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Parent's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Cell *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Cell/Phone *

(###)

###

####

*

By checking "Yes!" below you are stating that you understand the child attending Vacation Bible School at Trinity Lutheran Church will have a great time! The child may end up with minor play bumps, scrapes and/or bruises while attending. Their photo may be taken and posted on Trinity Lutheran web-media. They will be provided with a snack, songs that will get stuck in their heads, and a lot of God's Love!

Yes!

Give me a call, I'm on the fence.