VBS Registration Form 2023
For children ages 3 years through children entering 8th grade
Cost = $10.00 per child (this cost includes the registration - snack provided)
Dates = Monday, August 7th - Friday, August 11th
Time = 9:00am - 11:30am
Place = Peace Lutheran Church (4512 France Ave N, Robbinsdale, MN 55422)
VBS takes place at different locations around Peace Lutheran Church. Children can be dropped off and picked up in the Chapel (off of France Ave).

Checks can be made payable to "Peace Lutheran Church" with "VBS" in the memo line
Turn cash/check in to Peace Lutheran Church Office, VBS Box in Narthex, or Diane Mills
Money can be handed in on the first day of VBS

Questions or comments:
Diane Mills (612)298-9742
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*** One family per registration form - for friends, use separate forms so that their parents can sign at the bottom
Parent/Guardian's Name *
(First and Last)
Parent/Guardian's Home Phone *
Parent/Guardian's Cell Phone *
Parent/Guardian's Work Phone
Address *
City *
Zip Code *
Parent/Guardian's Email Address
Do you belong to a local church? *
Required
Do you belong to a local church, if yes which church?
Church Name
Emergency Contact During VBS (other than a parent) *
First and Last Name
Emergency Contact During VBS (other than a parent) *
Phone Number
Child 1 Name *
First and Last Name
Child 1 Age *
Child 1 Allergies/Health Concerns
I hereby give permission and consent to allow photographs and video images to be taken of Child 1 during participation in Peace Lutheran Church Vacation Bible School. I further give permission and consent for any and all such photographs, video images, and electronic images to be published by and used to illustrate and promote Peace Lutheran Church. I agree that Peace Lutheran Church may use photographs and video images for any lawful purpose, including for example purposes as publicity, illustration, advertising, and web content. Please know that no identifying information will be displayed without your consent. *
Required
Child 2 Name
First and Last Name
Child 2 Age
Child 2 Allergies/Health Concerns
I hereby give permission and consent to allow photographs and video images to be taken of Child 2 during participation in Peace Lutheran Church Vacation Bible School. I further give permission and consent for any and all such photographs, video images, and electronic images to be published by and used to illustrate and promote Peace Lutheran Church. I agree that Peace Lutheran Church may use photographs and video images for any lawful purpose, including for example purposes as publicity, illustration, advertising, and web content. Please know that no identifying information will be displayed without your consent.
Child 3 Name
First and Last Name
Child 3 Age
Child 3 Allergies/Health Concerns
I hereby give permission and consent to allow photographs and video images to be taken of Child 3 during participation in Peace Lutheran Church Vacation Bible School. I further give permission and consent for any and all such photographs, video images, and electronic images to be published by and used to illustrate and promote Peace Lutheran Church. I agree that Peace Lutheran Church may use photographs and video images for any lawful purpose, including for example purposes as publicity, illustration, advertising, and web content. Please know that no identifying information will be displayed without your consent.
Who, other than yourself, may pick up your child/ren?
First and Last Name
Who, other than yourself, may pick up your child/ren?
Phone Number
How did your hear about Peace Lutheran Church Vacation Bible School *
In case of medical emergency, I understand that every effort will be made to contact me. If parents/guardians cannot be reached, I give permission to VBS staff to secure proper treatment for my child/ren. *
Parent/Guardian First and Last Name
Parent/Guardian Date of Birth *
(used as a digital signature, along with name)
Submit
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