Wufoo

ELC Vacation Bible School Registration Form

This form is to provide registration information for anyone participating in the Epiphany Lutheran Church Discovery Canyon VBS July 13-17, 2009. VBS will meet 5-8pm with dinner provided at 5pm for all participants. Please fill out separate forms for each participant.

Name * First Last
Gender *
Female Male
Age and Grade Last Completed / Adult *
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number * ### - ### - ####
Email
Parent/ Guardian Names and Phone Numbers *
Emergency Contact Name and Phone Number (not parent or guardian) *
Medical Conditions/ Allergies/ Special Needs
Names of Other Family Members Attending
Do Not Fill This Out