Register TODAY for 
2017 "Gadgets & Gizmos" 
Vacation Bible School
July 24th - 28th
start
 
Child's Name: *

 
Birthdate: *

 
Grade (2017-2018) *

 
Gender *


 
More children to register? *

     
 
Child's Name: *

 
Age: *

 
Grade (2017-2018) *

 
Gender *


 
More children to register? *

     
 
Child's Name: *

 
Age: *

 
Grade (2017-2018) *

 
Gender *


 
More children to register? *

     
 
Child's Name: *

 
Age: *

 
Grade (2017-2018) *

 
Gender *


 
Parent/Guradian Name(s): *

 
Address: *

 
Phone: *

 
Allergy/medical condition:

 
Church affiliation:


 
Emergency contact if parent is unavailable: *

 
Emergence contact phone number: *

 
I would like to help in the following way:


 
I will need care for a young child while I volunteer.

     
 
Electronic consent *

I, the parent/guardian of the child(ren) listed above, hereby authorize a representative of Central Lutheran Church to authorize emergency healthcare for my child(ren) if necessary. I hereby hold the staff and/or volunteers of Central Lutheran Church harmless for any injury or harm that my son/daughter may incur while participating in the Vacation Bible School program. (Note: Photos of activities and events are occasionally used for publication on our website, brochures, newsletters, etc.  If you do not wish to have your child’s picture published, please notify the church office.)
     
You have successfully registered for "Gadgets & Gizmos" 2017 
Vacation Bible School - July 24-28
@ Central Lutheran

For any questions please contact Whitney Falkenberg,
whitney@central-lutheran.org
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