REGISTRATION FORM

                                VBS 2008

Name of Child               Birthdate/Grade Completed*            Allergies**

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Place my child in class with:______________________________________

(Child must be same age – Switching classes once VBS has started will not be permitted.)

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Parent’s Name_________________________________________________

Street_________________________City_____________Zip Code________

Home Phone_________________      Cell Phone______________________

Emergency Contact (Name, telephone & relation to child)

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Pediatrician’s Name & Telephone

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Church which you attend regularly __________________

Signature__________________________

Please mail form with registration fee*** by June 16, 2008 to:

Holy Trinity Lutheran Church 240 Lincoln Ave., RVC, NY  11570

*Nursery school children must have completed a 3 or 4 year program prior to VBS.     

  Sorry, no toddlers.  Parents will not be allowed to stay with their child.

** Please list any medical problems that we should be aware of (allergies, medications, etc)

*** Registration Fee is $20.00 per child.

I would like to volunteer!! (Please indicate how you can help)___________

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