Please complete this registration form for your child(ren). VBS is open to children age 3 through 6th grade.
Three-year-olds should be 3 by August 1, 2017. VBS cost is $15 per child with a $45 maximum per family.
Scholarships are available; please contact John Holt or Pastor DaveĀ for scholarship details.

* 1. Name of Child(ren)

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

* 3. School Grade in Fall of 2017

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

* 5. Street Address, City, State, Zip

* 6. Home Phone and Cell Phone

* 7. Email Address

* 8. Emergency Contact Name and Contact Number

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

* 10. Medical Concerns (including allergies)

* 11. Behavioral Concerns

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

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

* 14. Parent/Guardian Electronic Signature

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