Registration for Vacation Bible School

St. Timothy Lutheran Church

June 16-21, 2008

Monday thru Friday 5:45 - 8:15 p.m.

Saturday Closing Program 12:00 - 12:30 p.m.

Saturday Closing Picnic 12:30 - 1:30 p.m.

Age 3 thru Grade 5

Child’s name*: _____________________________________________

Age________ Birthdate__________ Last Grade Completed__________

Address:___________________________________________________

__________________________________________________________

Phone (home):______________________________________________

Phone (cell):________________________________________________

Phone (other):_______________________________________________

Parent/Guardian Name:_____________________________________

In case of emergency (when parent/guardian cannot be reached) please contact:

Name:___________________________________________

Phone Numbers:______________________________________

Person responsible for picking up my child at the end of each VBS night:

___________________________________________________________

Please list any allergies or medical conditions the VBS staff should be

aware of:  __________________________________________________

__________________________________________________________

Please sign:

I ________________________ give permission for my child to be photographed for use in St. Timothy’s newsletter, scrapbook, or on it’s informational website.

           *All small children must be potty trained.