Planet Zoom
2011 VBS REGISTRATION FORM
Holy Cross Lutheran Church
4041 W. 120th St.
Alsip, IL 60803
July 17-21, 2011
5:45 - 8:30 PM
"Big Jungle Adventure"

 
Required fields noted with * and light yellow highlite.
Printout Blank VBS Registration Form to fill out & mail In. (PDF)


   VBS STUDENT INFORMATION (Register one child per registration form.)

  *LastName Child’s:      *First Name Child’s:

  *Last Name Parent’s:  *FirstName Parent's:

  *Child's Address: *City: *State: *Zip:

  *Home Telephone #1:                            Home Telephone #2: 

  Mother's Cell Phone #:                         Father's Cell Phone #:

  E-mail Address:           

  *Child’s Birth Date:                           *Grade in Fall:

  Family Church:            

  Special Needs:           

  Allergies (all kinds):    

   AUTHORIZED PEOPLE to pick up your child
   WHEN PICKING UP CHILD PLEASE BE PREPARED to show identification.

  *Last Name: *First: *Phone:

    Last Name:  First:  Phone:

    Last Name:  First:  Phone:

   EMERGENCY CONTACT

  *Last Name:           *First Name:

  *Relationship:             *Phone #:


   How did you find out about our VBS?

  


   Have you or are you planning to attend another VBS this summer?
  



  

   Would you like to purchase a T-Shirt transfer?   
  
(Please plan on paying any t-shirt order at time of registration)   

           

Thank you for your VBS registration.

NOTE:
PARENT OR LEGAL GUARDIAN MUST BE PRESENT TO SIGN THIS PRE-REGISTRATION FORM ON THE FIRST DAY OF VACATION BIBLE SCHOOL.

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