St. John's Lutheran Church
815-338-5159
Register me for the
Friendship Trek
(One form per child, please)
Child's Name
Grade completed
Birthdate
Age
Parent's Names
Address
Home Phone
Cell Phone
Emergency Contact
Relationship to Student
Home Phone
Alt. Phone
Food Allergies or
Other Medical Problems
(please list)
Family Doctor
Phone
Siblings Attending VBS
(names and ages)
Church Affiliation
Church Membership at
People who may pick up the child
(please list full name of each person)
Attendance
1 2 3 4 5
By clicking the SUBMIT button below, you give permission for any photos taken of the child being registered during the course of Vacation Bible School to be used in newspaper articles, website publications, and/or other media. No personal information about the child (name, address, age, etc.) will be published.
