Vacation Bible School 2025

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Home

Mobile

Work

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Child 1 Registration *

First Name

Last Name

Gender *

Female

Male

Date of Birth *

MM

DD

YYYY

Does your child have any medical or allergy concerns you need to share? *

Yes

No

Child 2 Registration (if applicable - if no other registrations, please scroll to the next section)

First Name

Last Name

Gender

Female

Male

Date of Birth

MM

DD

YYYY

Does your child have any medical or allergy concerns you need to share?

Yes

No

Do you want to register additional children?

No

Yes

As a parent of legal guardian of the child(ren) I register, I give permission to Rock of Ages Lutheran Church to publish for its own use any pictures of my child(ren) taken during this program. *

I Agree

As a parent of legal guardian of the child(ren) I register, I authorize Rock of Ages Lutheran Church VBS staff to administer First Aid or Emergency care to my child(ren) if needed. I will not hold Rock of Ages Lutheran Church liable for any care given in an emergency. *

I Agree