Vacation Bible School Registration 2019
Immanuel, God with us, touching lives through Christ!
Our Mission Statement:
Evangelical Lutheran
Church in America
God's work. Our hands.

Child's Name:                                                              Child's Birthdate:                                
Grade Level Just Completed:

Child's Name:                                                              Child's Birthdate:  
Grade Level Just Completed:

Child's Name:                                                              Child's Birthdate:  
Grade Level Just Completed:

Child's Name:                                                              Child's Birthdate:  
Grade Level Just Completed:


Home Address:                                                                       Phone Number:                                              

Email: 

Parent Name:                                                                   Parent Work Phone: 



Emergency Contact:                                                                                Phone:


*Allergies or Other Medical Conditions:     




*If your child has an allergy to food, please approve the day's snacks with the kitchen staff, signing for approval or bring a snack.

Name of Home Church:

PHOTOGRAPH RELEASE​
I hereby grant permission for Immanuel Lutheran Church to use pictures of my child on it's website and/or Facebook page 

                                                                                                        **Signature:                                                          
**By typing my name I am agreeing it is the electronic representation of my signature.


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