Parent's Names(s) * Email *

Street Address* City* State* Zip *

Home Phone* Work Phone*

Church Affiliation* Church Membership*

Child's Name* Session * -- 1 2 Age* Last Grade Completed * Date of Birth* Baptized?* No Yes

Shirt Size* -- Y XS Y S Y M Y L YXL Adult S Known Allergies or Medical Problems (if None, Please state) *

Food Allergies: Are traces acceptable for your child? No Yes

Child's Name Session -- 1 2 Age Last Grade Completed Date of Birth Baptized? No Yes

Shirt Size -- Y XS Y S Y M Y L YXL Adult S Known Allergies or Medical Problems (if None, Please state)

Food Allergies: Are traces acceptable for your child? No Yes

Child's Name Session -- 1 2 Age Last Grade Completed Date of Birth Baptized? No Yes

Shirt Size -- Y XS Y S Y M Y L YXL Adult S Known Allergies or Medical Problems (if None, Please state)

Food Allergies: Are traces acceptable for your child? No Yes

Child's Name Session 1 2 -- Age Last Grade Completed Date of Birth Baptized? No Yes

Shirt Size -- Y XS Y S Y M Y L YXL Adult S Known Allergies or Medical Problems (if None, Please state)

Food Allergies: Are traces acceptable for your child? No Yes

Cost for Vacation Bible School is $15 per child. Family (single household) maximum $40
All participants will receive a T-shirt

AUTHORIZATION FOR EMERGENCY MEDICAL CARE

Emergency Contact* Phone Number*

Relation*

I give Hope Lutheran Church and Preschool permission to publish a photo of my child/children for use in their website, newsletter or other public materials.

I agree -- Yes No

Payment Method * --- Paypal Check Scholarship For Paypal use link on page following the completion of this form - Checks mail to church office attn VBS or drop off at VBS table.