You are registering for 2021 Vacation Bible School - Monday, 7/19 - Thursday, 7/22

Registration Form created by Faith Klemick
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Note/Comment icon 9:00 a.m. - 11:30 a.m.
Saint Peter Lutheran Church
130 Nittany Drive, Mechanicsburg, 17055
(717) 766-2701
For children ages 4 - entering 6th grade. Children must turn 4 by 7/18/21 and must be potty trained to attend.
Please read the following Photo Consent, Emergency Release, and Covid-19 Release statements for your consideration:
Please complete 1 form per child attending. Direct any questions to Faith Klemick at Thank you!

Child's Name*
Parent/Guardian Names*
Parent/Guardian Phone Number during VBS*
Primary Email Address*
Emergency Contact (in case parent/guardian can't be reached)*
Emergency Contact's Phone Number*
Emergency Contact's Relationship to Child*
If yes, please list food allergies
Other allergies or medical concerns?
Child's Doctor*
Doctor's Phone Number*
Person(s) OTHER Than Parent/Guardian who may pick up your child
Relationship to Child
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