VBS Registration Form 2019

Use this form to register students for Resurrection's 2019 Vacation Bible School.

  
Name
  
Youth or Adult Participant?
  
  
Gender
  
  
Address
  
City
  
State
  
Zip Code
  
Date of Birth
  
Age as of June 1, 2018
  
Last School Grade Completed
  
Tee Shirt Size
  
  
Parent/Family/Guardian Name
  
Email
  
Home Phone
  
Cell Phone
  
Work Phone
  
Currently Taking Medication?
  
Allergies or Other medical needs we should know about?
  
Emergency Contact 1
  
Phone Number 1
  
Emergency Contact 2
  
Phone Number 2
  
Dismissal Information: Name(s) of person(s) who may pick up this child from VBS.
  
I give Resurrection Lutheran Church permission to use any photograph/video of my child during any activities in future promotional materials, news releases or websites.
  
  
Electronic Signature
  
Today's Date

1919 Independence Pkwy Plano, Texas 75075 USA
 Contact Us
 972-867-0460    972-758-7921 (fax)
 8:30 - 4:30 M-F
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PURPOSE: To unite as many persons as will share its confession of faith in a fellowship of Worship, Learning, Witness and Service that the Word of God in Jesus Christ may become effective in their lives together and individually.