Vacation Bible School Registration

REGISTRATION form

Lischey's VBS is for kids from age 2 (with a parent) through those who will finish 6th grade this year. Fill out the form below to sign up!

Name of Parent(s)

Parent's Address

Parent's Phone

Parent's Email

In Case of Emergency, contact:

Emergency Contact Phone Number:

Emergency Contact's Relationship to Child(ren)

Name of additional guardian (18 years or older) if parent is unable to attend/ pickup

Child #1 Name

Child #1 Date of Birth

Child #1 Last Grade Completed

Child #1 Allergies

Child #2 Name

Child #2 Date of Birth

Child #2 Last Grade Completed

Child #2 Allergies

Child #3 Name

Child #3 Date of Birth

Child #3 Last Grade Completed

Child #3 Allergies

I grant to St. Peter's Lischey's UCC the right to take photographs and/or video of myself and family in connection with the above-identified event. I authorize St. Peter's Lischey's UCC to use and publish the images or video in print, or electronically, for example, our website content.

Yes

By clicking "Submit", you are registering your family and agree to the following: You agree to release St. Peter's Lischey's UCC, its staff, directors, volunteers, and anyone connected or associated with the church from any liability for injuries/illness to your family arising out is his/her/their participation in this event.

Submit

dive Below the Surface to Build a Strong Faith

REGISTRATION form

Lischey's VBS is for kids from age 2 (with a parent) through those who will finish 6th grade this year. Fill out the form below to sign up!