Please complete this registration form for your child(ren). VBS is open to children age 3 through entering 6th grade in fall 2019.
Three-year-olds should be 3 by August 1, 2019. VBS cost is $15 per child with a $45 maximum per family.
Scholarships are available; please contact Pastor DaveĀ for scholarship details. VBS is July 22-25, 2019.

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* 1. Name of Child(ren)

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* 2. Name(s) of Parent(s)/Guardian(s)

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* 3. School Grade in Fall of 2019

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* 4. Birthday(s) and Age(s)

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* 5. Street Address, City, State, Zip

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* 6. Home Phone and Cell Phone

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* 7. Email Address

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* 8. Emergency Contact Name and Contact Number

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* 9. Name and Relationship of Adults Approved to Pick-Up your Child(ren) from VBS

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* 10. Medical Concerns (including allergies)

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* 11. Behavioral Concerns

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* 12. Do you authorize Salem Lutheran Church to publish photos of your child(ren) in congregational publications?

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* 13. T-SHIRT SIZE (YOUTH S M L XL)

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* 14. Parent/Guardian Electronic Signature

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