VBS 2021 Registration Form

2021 VBS Registration Form
For participation in VBS on Saturday, July 24 from 9am-1pm
Please complete one form per family.

Youth Information

Child Number 1

* Indicates required field

Name *

First

Last

Nick Name *

Birth Date *

Age *

Grade Completed *

Child Number 2

Name *

First

Last

Nick Name *

Birth Date *

Age *

Grade Completed *

Child Number 3

Name *

First

Last

Nick Name *

Birth Date *

Age *

Grade Completed *

Child Number 4

Name *

First

Last

Nick Name *

Birth Date *

Age *

Grade Completed *

Primary Address

Street *

City *

State *

Zip Code *

Parent/Guardian Information

Parent/Guardian 1 *

First

Last

Best Phone Number *

Email *

Home Church *

Parent/Guardian 2 *

First

Last

Best Phone Number *

Email *

Emergency Contacts and Medical Information

Emergency Contact 1 *

First

Last

Best Phone Number *

Relation *

Please list any allergies, medical conditions and/or other helpful information or questions FOR EACH CHILD *

Media Consent

I grant permission for FULC to use photos taken of my child during VBS 2021 for the following promotional purposes (children's names will not be used and they will not be "tagged" in photos).

FULC Website *

Any Photos Only Group Photos NO Photos

FULC Facebook *

Any Photos Only Group Photos NO Photos

FULC Newsletter (email/FB) *

Any Photos Only Group Photos NO Photos

SIGNATURE

By entering your full name and date in the boxes below you are effectively providing your signature, indicating that all the information on this form is true and accurate to the best of your knowledge.

Name of Parent/Guardian *

Date *

Submit

2021 VBS Registration FormFor participation in VBS on Saturday, July 24 from 9am-1pm​Please complete one form per family.

Youth Information

Parent/Guardian Information

Emergency Contacts and Medical Information

Media Consent

SIGNATURE

fIRST uNITED lUTHERAN cHURCH, kENNESAW, gaCongregational Mission Statement:First United Lutheran Church is called to worship, serve, and learn together as we grow disciples​of Jesus Christ for God's mission of love for the world.

2021 VBS Registration Form
For participation in VBS on Saturday, July 24 from 9am-1pm
Please complete one form per family.

fIRST uNITED lUTHERAN cHURCH, kENNESAW, ga

Congregational Mission Statement:
First United Lutheran Church is called to worship, serve, and learn together as we grow disciples
of Jesus Christ for God's mission of love for the world.