Zion Lutheran (LCMS) VBS 2010
Planet Zoom - July 12 -16, 2010
Registration Page
Fill in the form below for each child and email.
Child's Name:
*
Grade Completed:
*
Birthday:
*
Age:
*
Parents Name:
*
E-Mail Address:
Home Address:
*
Home Phone:
*
Alternate Phone:
People who may pick up the child:
*
Emergency Contact Person:
*
Relationship to Student:
*
Telephone:
*
Food Alergies:
List:
Medical Conerns:
Explain:
Family Doctor & Phone #:
Siblings Attending:
Church Affiliation:
Membership At:
Transportation Needed?:
Check if OK for child to be in photographs:
Type your name as a signature:
*