VBS Electronic Form

Immanuel Lutheran Church

600 4th Steet SW

Crosby, MN 56441

218-546-6010

VACATION BIBLE SCHOOL

August 2 – 5, 2021

5:30p – 7:00p

immanuelcrosby.org

Please fill out the following information - one registration per family.

First & Last Name

If Child: Age

Date if Birth

First & Last Name

If Child: Age

Date if Birth

First & Last Name

If Child: Age

Date if Birth

First & Last Name

If Child: Age

Date if Birth

Parent/Guardian Name

First & Last Name

Will the parents/guardians be attending VBS with the children?

Yes

Will parents be working at a station during VBS?

Yes

If Yes, which station?

Parent/Guardian Address

Country

City

State

Zip code

Best Contact Phone

Email Address

Home Church

Medical Issues

Please list any allergies or medical conditions for which the staff needs to be aware.

Emergency Contact

Other than Parent/Guardian

Phone

Relationship

Do you give permission for the church to use a photo of your child in church publications (including social media)?

Yes

Messages or Comments

Or add more children, if needed.

Suggested donation of $10 per child or $30 per family to help with VBS expenses. No one will be turned away because of an inability to pay. Please make checks payable to Immanuel Lutheran Church. Any questions, please call 218-546-6010.

Immanuel Lutheran – Crosby

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