Student Information *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Is your child potty-trained? *

Yes

No

If no, do adult volunteers have permission to help your child in the bathroom, or do you plan to attend VBS with your child to help in the bathroom? *

Yes, volunteers have permission to help my child in the bathroom

No, volunteers do not have permission to help my child in the bathroom

I plan to attend VBS with my child

Not applicable, my child is potty-trained

Parent/Guardian Information *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Can pictures of your child from St. Paul's VBS be included in any publicity put together by St. Paul's Lutheran Church, including but not limited to the church bulletin board, church website, Facebook, etc.? *

Yes

No