Zion Lutheran Vacation Bible School
June 17th thru June 21st - 9am to Noon

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On-Line 2024 Registration Form

PDF version here !

Please Note: ** are required fields

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Children Sign-Up

Child Name

Age:

Grade:

Child Name

Age:

Grade:

Child Name

Age:

Grade:

Child Name

Age:

Grade:

Personal Information

Guardian Name:

Address

City:

State:

Zip:

Email:

Primary Phone:

Alternate Phone:

Emergency Contacts

Name:

Phone:

Name:

Phone:

Child(s) Escort to/from Zion Church

Name:

Relationship:

Special Information

Do any of the children listed have medical conditions , food allergies, or learning difficulties?
If Yes, please note:

Please read this statement before signing Authorization: I give permission for my child/children to participate in Vacation Bible School activities at Zion Lutheran Church. I authorize Zion Lutheran Church to use pictures in which my child/children appear that may be displayed in the church, sent to a newspaper for publication, or on the ZLC website/Facebook. In the event of an emergency, I hereby give permission to Zion Lutheran Church volunteers or personnel to act on my behalf for medical assistance for my child/children until such time as I can be contacted.

Authorization

Signature Name:

Date:

Zion Lutheran Church ELCA
"1113 SW Black Butte Blvd    Eric Burtness, Pastor
Redmond, Oregon 97756    Office: (541) 923-7466

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Zion Lutheran Vacation Bible School June 17th thru June 21st - 9am to Noon

On-Line 2024 Registration Form

Do any of the children listed have medical conditions , food allergies, or learning difficulties? If Yes, please note:

Zion Lutheran Vacation Bible School
June 17th thru June 21st - 9am to Noon

Do any of the children listed have medical conditions , food allergies, or learning difficulties?
If Yes, please note: