Peace Janesville Lutheran Church » VBS Electronic Registration

Child's Name (one form per child)*

Age?*

Parents Name(s)*

Home Address*

Phone Number 1*

Phone Number 2 (Optional)

Last Grade completed*

MORNING ONLY (9 a.m.-Noon) or ALL DAY (9 a.m. to 3 pm)*

All Day
Morning ONLY

Any Special Needs/ Allergies / Information?*

No
Yes

If YES, Please tell us Allergy / Need / Restrictions

Emergency Phone Number*

Current Church Membership

Have a Church Home
Looking for a Church Home
Member at Peace Lutheran, Janesville
No current Church Home

Would you like materials from our Church?

No
Yes

Comments?

How did you hear about Peace Vacation Bible School?

At another VBS
Got a flyer at my home
Member of Church told me about it
Newspaper
Other
Radio
Website

Thanks for registering electronically!

*INDICATES REQUIRED ANSWER