VBS Online Registration Form

July 6-10, 2009
9-11:30 a.m.
Children ages 3 through those entering 5th grade

Family Information

Parents' Names: *

Home Address:

City/State/ZIP:

Email Address: *

Home Phone#:

Primary Cell #:

Emergency Contact Name:

Emergency Contact Phone#:

Student

Child's First & Last Name: *

Date of Birth: *

Age in years:

2008-09 School Grade:

Did your child attend VBS last year? YESNO

Known Allergies/Medical Problems

To add another child, please click the "Add Child" to the right

Add Child

VBS Volunteering

Volunteers are still needed. There are many jobs that need to be filled, so all help is appreciated. If you can help in any way, please select yes below.

Would you be willing to help out with VBS? YesNot at this time

PHOTO - VIDEO RELEASE

I give permission for my child’s photo, which may be taken during classes, to appear in The Peace Lutheran Church - Monthly Newsletter or on the Church's Website www.peaceplainfield.org. **checking "I agree", will serve as your parental/guardian consent * I agreeI do not wish for my child's picture to be used

If you have any questions please contact the church office at (815) 436-9847 or email plc@peaceplainfield.org

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