VACATION BIBLE SCHOOL REGISTRATION 2010
(One form per child please)
July 26th – 31st 8:45 a.m. – Noon
Child’s name_______________________________________________________________
Grade completed___________________________________________________________
Birthday_________________________________________ Age________________
Parents’ names______________________________________________________________
Home address______________________________________________________________
Home phone_______________________________________________________________
Alternate phone_______________________________________________________________
Email Address__________________________________________________________________
Emergency contact person_______________________________________________________________
Relationship to student______________________________________________________________
Home phone__________________Cell phone______________________________
Food allergies______________________________________________________________
Medical concerns____________________________________________________________
Family doctor_______________________
(over)
Doctor’s phone_________________________
Church Affiliation____________________________________________________________
People who may pick up the child ____________________________________________
VBS leaders have permission to photograph/film the minor designated above in any manner or form for any
lawful purpose associated with this VBS program.
__________________________________________________
Parent’s signature
Please return by July 15th to Redeemer Lutheran Church or call Krista Geisendorfer (973)362-0305.
Form can also be faxed to 973-383-3954.