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Vacation Bible School Registration
Vacation Bible School June 2nd – 5th, 2025 8:30AM – Noon
** Please note - VBS is only Monday - Thursday!!
There are no costs associated with VBS
Bethany Lutheran Church
1334 Griffin Road
Leesburg, FL. 34748
(352) 787-7275
Please complete one form for each child
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Child's Name
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Age
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Date of Birth
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Grade (just completed, May 2025)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
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Parent / Guardian Name(s)
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Home Address
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Home Phone
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Work Phone
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Mobile Phone
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Email
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Preferred Contact Method
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Primary Emergency Contact & Phone Number
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Secondary Emergency Contact & Phone Number
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Name of Doctor
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Doctor's Phone Number
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Allergies or Special Needs
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At Dismissal - Who may pick your child(ren) at the end of the day? List Name and Relationship.
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Is there any other information you feel would be necessary for us at Vacation Bible School?
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Please type the name of person who completed this registration and relationship to child(ren)
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