2025 Vacation Bible Camp Registration
Hosted by: Bethlehem Lutheran Church
9748 Copeland Drive, Manassas, VA 20109
www.bethlehem-lutheran.org

Please fill out a separate form for each child attending VBS with us!
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Email *
Child's Full Name *
Last Grade Completed (choose one) *
Required
Date of Birth: *
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Child's Age: *
Child's T-shirt Size (choose one) *
Parent Name: *
Home Address: *
Home Phone: *
Cell Phone: *
Emergency Contact Person: *
Emergency Contact's Relationship to Child: *
Emergency Contact Phone: *
Emergency Contact Alternate Phone: *
List of people who may pick up your child: *
Food Allergies? *
If yes to Food Allergies, please list: *
Medical Concerns? *
If yes to Medical Concerns, please explain: *
Digital Images - Pictures and video recordings may be taken of your child during Bible Camp activities.  Some of these images will be used in a slideshow presentation for our final day of camp on Friday, August 8.  Children's names will NOT be included in this presentation. *
Please confirm that you will ensure your child has a bottle of water and sunscreen pre-applied each day of Bible Camp.
 *
How did you hear about our Bible Camp? *
NOTE:
*If your child is not able to attend Bible Camp once you've registered, please notify us as soon as possible at admin@bethlehem-lutheran.org.  Thank you for this courtesy!
A copy of your responses will be emailed to the address you provided.
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