VACATION BIBLE SCHOOL

2025 Vacation Bible School Registration

Date: Monday, June 9th – Thursday, June 12th

Time: 5:30pm – 8:00 pm (Dinner Included)

Location: Gethsemane Lutheran Church

Please have childern arrive by 5:20pm for Check-in / Registration

Family Information

Parent/Guardian Name(s)

Address

Home Phone

Cell Phone

Work Phone

Participant #1

Child's Name (Last, First)

Birthdate

Last Grade Completed

Allergies, Medications, and/or Medical Conditions

Activity Restrictions

Insurance Information:

Insurance Company

Policy/GroupID#

Emergency Contact: Person(s) & phone numbers in case parent/guardian cannot be reached:

Name(s)

Contact Phone

People authorized to pick up my child

Name(s)

Contact Phone

Participant #2

Child's Name (Last, First)

Birthdate

Last Grade Completed

Allergies, Medications, and/or Medical Conditions

Activity Restrictions

Insurance Information

Check if different then Participant #1

Insurance Company

Policy/GroupID#

Emergency Contact

Check if different then Participant #1

Name(s)

Contact Phone

People authorized to pick up my child

Check if different then Participant #1

Name(s)

Contact Phone

Participant #3

Child's Name (Last, First)

Birthdate

Last Grade Completed

Allergies, Medications, and/or Medical Conditions

Activity Restrictions

Insurance Information

Check if different then Participant #1

Insurance Company

Policy/GroupID#

Emergency Contact

Check if different then Participant #1

Name(s)

Contact Phone

People authorized to pick up my child

Check if different then Participant #1

Name(s)

Contact Phone

Participant #4

Child's Name (Last, First)

Birthdate

Last Grade Completed

Emergency, Medications, and/or Medical Conditions

Activity Restrictions

Insurance Information

Check if different then Participant #1

Insurance Company

Policy/GroupID#

Emergency Contact

Check if different then Participant #1

Name(s)

Contact Phone

People authorized to pick up my child

Check if different then Participant #1

Name(s)

Contact Phone

VACATION BIBLE SCHOOL

Family Information

Participant #1

Participant #2

Participant #3

Participant #4

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registration recieved