VBS Registration

REGISTRATION FEES
(please pay at church office):
$25 per child
$35 for 2 children (of same family)
$40 for 3 children (of same family)
(LCOS members - no fees)

Pre-Kindergarten and Kindergarten:
Please bring a change of clothes on first day.

Child's Name
Grade entering in Fall 2018
Parent(s)
Home Address
City
Phone
Alternate Phone
Email
Additional person(s) authorized to pickup child?
Emergency Contact Person
Emergency Contact Person Phone
Emergency Contact's Relationship to Child
- Allergies (Food/Other)?
- No
- Yes
List Allergies
- Medical and/or Special Concerns?
- No
- Yes
Medical and/or Special Concerns
Child's Doctor
Doctor's Phone
Siblings attending LCOS VBS (names/ages)
Child's Free t-shirt Size
Person filling out this form
Today's Date