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2017 Trinity Lutheran Church Vacation Bible School Registration
Event Timing: June 19th-22nd, 2017
Event Address: Trinity Lutheran Church, 47 W. Main Street, Mount Joy PA
Contact us at (717)653-4168
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Email *
Child #1 Name *
 Child #1 Age on June 19, 2017 *
Child #1 Grade Just Completed (list "preschool" if not yet in school) *
Child #1 Dietary or Physical Restrictions, Allergies, Medications, etc.  Please list and be specific or write none. *
Child #1 Name of a special friend your child might like to be with for the week: (If you are visiting from another church and would like your child paired with a friend at TLC, please list his/her name and grade.)
Child #1 Will Attend *
Required
Child #2 Name (if applicable)
Child #2 Age on June 19, 2017
Child #2 Grade Just Completed (list "preschool" if not yet in school)
Child #2 Dietary or Physical Restrictions, Allergies, Medications, etc.  Please list and be specific or write none.
Child #2 Name of a special friend your child might like to be with for the week: (If you are visiting from another church and would like your child paired with a friend at TLC, please list his/her name and grade.)
Child #2 Will Attend
Child #3 Name (if applicable)
Child #3 Age on June 19, 2017
Child #3 Grade Just Completed (list "preschool" if not yet in school)
Child #3 Dietary or Physical Restrictions, Allergies, Medications, etc.  Please list and be specific or write none.
Child #3 Name of a special friend your child might like to be with for the week: (If you are visiting from another church and would like your child paired with a friend at TLC, please list his/her name and grade.)
Child #3 Will Attend
Child #4 Name (if applicable)
Child #4 Age on June 19, 2017
Child #4 Grade Just Completed (list "preschool" if not yet in school)
Child #4 Dietary or Physical Restrictions, Allergies, Medications, etc.  Please list and be specific or write none.
Child #4 Name of a special friend your child might like to be with for the week: (If you are visiting from another church and would like your child paired with a friend at TLC, please list his/her name and grade.)
Child #4 Will Attend
Parent/Guardian Names *
Parent/Guardian Cell Phone Numbers *
Emergency Contact (Full Name, Relationship, Cell Phone Number) *
Mailing Address *
Medical Permission - My child has/children have my permission to participate in youth events at Trinity Lutheran Church, Mount Joy PA. In the event that I can not be found, permission is given to have treatment in a medical facility as deemed necessary. *
Photo Permission - We at Trinity Lutheran Church occasionally use the photographs of children and youth for websites, newsletters, and other in-house publications. It is our practice to not list the name of the child or youth with the photograph. *
The undersigned does hereby agree to hold harmless, release, remise, acquit and forever discharge Trinity Lutheran Church, its staff, employees, volunteers, agents, successors and assigns, of and from all claims, demands, causes of action, obligations, rights, damages, losses, expenses, costs, joinders or controversies arising out of my child’s/my children's participation in any program or any activities with Trinity Lutheran Church. *
A copy of your responses will be emailed to the address you provided.
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