St. Paul's VBS 2024 Registration

July 15-19, 2024. 9a.m-11:30a.m. | St. Paul's Lutheran Church VBS 2024 Registration
Grades: Entering K-6th

Parent or Guardian Information

Parent or Guardian Name(s)

*

Address

*

Phone

*

Email

*

This address will receive a confirmation email

Child 1 Information (If more than one child, fill out ALL optional fields)

Child's Name

*

Birth Date

*

Grade Entering Fall 2024

*

Allergies

*

T-Shirt Size

*

Please select all that apply.

Youth S Youth M Youth L Adult S Adult M Adult L

Child 2 Information

Child's Name

Birth Date

Grade Entering Fall 2024

Allergies

T-Shirt Size

Please select all that apply.

Youth S Youth M Youth L Adult S Adult M Adult L

Child 3 Information

Child's Name

Birth Date

Grade Entering Fall 2024

Allergies

T-Shirt Size

Please select all that apply.

Youth S Youth M Youth L Adult S Adult M Adult L

Emergency Information

Emergency Contact (other than above)

*

Emergency Contact Phone

*

Emergency Contact relationship to child

*

Health Insurance Carrier Name and Group Number

*

Consent for emergency medical treatment if parents cannot be reached

*

Please select all that apply.

Yes No

Consent to publish photos with your child, no names used

*

Please select all that apply.

Yes No

Does child attend church? If so, where?

*

Payment Online With Credit Card or In Person with Check or Cash, Click for Selection

One Child ($20) Two Children ($40) Three Or More Children ($60) Pay in Person (0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

July 15-19, 2024. 9a.m-11:30a.m.

St. Paul's Lutheran Church VBS 2024 Registration
Grades: Entering K-6th

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