You are registering for 2019 Vacation Bible School - DRAWN TO THE LIGHT!

    Registration Form created by Faith Klemick
    Easy share URL: ttsu.me/jgra9m

    July 22, 23, 24, and 25 (Monday - Thursday)
    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 7/21/19 and must be potty trained to attend.
    Please complete 1 form per child attending.
    Direct any questions to Faith Klemick at faithinphilly@yahoo.com. Thank you!

  1. How did you learn about our VBS program?
  2. Child's Name
    (required)
  3. Grade That Will Be Completed by July
    (required)
  4. Age (Must be 4 years old and potty trained by 7/21/2019)
    (required)
  5. Date of Birth
    (required)
  6. Parent/Guardian Names
    (required)
  7. Address
    (required)
  8. Primary Phone Number
    (required)
  9. Alternate Phone Number
    (required)
  10. Primary Email Address
    (required)
  11. Emergency Contact
    (required)
  12. Emergency Contact's Phone Number
    (required)
  13. Emergency Contact's Relationship to Child
    (required)
  14. Does your child have any food allergies?
    (required)
  15. If yes, please list food allergies
  16. Other allergies or medical concerns?
  17. Child's Doctor
    (required)
  18. Doctor's Phone Number
    (required)
  19. Siblings Attending VBS
  20. Person(s) OTHER Than Parent/Guardian who may pick up your child
  21. Relationship to Child
  22. May we take photos of your child while at VBS?
    (required)
  23. Remember me on this computer
  24. By using TimeToSignUp.com, you agree to the Terms of Use.