Peace Lutheran Church VBS Registration Form

Peace Lutheran Church & In Season Ministries

VACATION BIBLE SCHOOL
Vacation Bible School Registration Form
1801 Port Malabar Blvd Palm Bay, FL 32909

(321) 727-3131
JULY 11 - 15, 2022

9:00AM - 12:30PM

Classes are for K - 5th Grade.

(Kindergarteners must have completed Kindergarten and entering 1st Grade in August)

COST: FREE!!!

(Limit of 75 children. Please register early to ensure a place for your child/children)

Last day of online registration: Friday, July 1st at 5:00PM
Parents Name *

Prefix First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
example@example.com
Phone Number *
Cell Number
Emergency Contact *

First Name Last Name
Phone Number *
Cell Number
Child 1 *

First Name Last Name
Birth Date *

Month Day Year
Age: *
Grade Level Completed *
Allergies *
**Please pack a snack for your child if he/she has food allergies.**
Child 2

First Name Last Name
Birth Date

Month Day Year
Age:
Grade Level Completed
Allergies *
**Please pack a snack for your child if he/she has food allergies.**
Child 3

First Name Last Name
Birth Date

Month Day Year
Age:
Grade Level Completed
Allergies *
**Please pack a snack for your child if he/she has food allergies.**
Child 4

First Name Last Name
Birth Date

Month Day Year
Age:
Grade Level Completed
Allergies *
**Please pack a snack for your child if he/she has food allergies.**
Please list any special needs, special diet, medications, etc. that your children may have: PLEASE NOTE THAT WE CANNOT ADMINISTER MEDICATIONS AT VACATION BIBLE SCHOOL! *
IMPORTANT NOTE: People that are allowed to pick-up your child at the end of the day, MUST show identification and their names must be on the list. There are NO exceptions! You must call the office at (321)727-3131 between the hours of 8:30AM – 12:30PM, if you are adding/taking someone’s name off of the list. PLEASE ADD THE NAME/NAMES OF THE PEOPLE/PERSON BELOW WITH PHONE NUMBER INFORMATION. *
Is your child allowed to have his/her picture taken in conjunction with Vacation Bible School? *

Yes No
PARENTS ARE ENCOURAGED TO VOLUNTEER ONE, TWO DAYS (OR MORE).
What day's are you available?

Monday Tuesday Wednesday Thursday Friday
Should be Empty:

Peace Lutheran Church & In Season Ministries

Vacation Bible School Registration Form

1801 Port Malabar Blvd Palm Bay, FL 32909