Parent/Guardian Name (required)

Address (required)

Primary Phone (required)

Secondary Phone

Email (required)

Do you attend St. Luke's?
yesno

List name(s) of students on separate lines

List birthdate(s) of students on separate lines

List grade(s) of students on separate lines.

Please describe any additional information or special needs about the child(ren) you are registering

T-shirt Size(s)

List any other VBS participants your child would like to be partnered with.

Emergency Contact Name

Emergency Contact Phone

Relationship of Emergency Contact to your child(ren)

Please list adults who are approved to pick up your child(ren)

Please type your name below
This serves as your signature

Date

Photo Permission
yesno