VBS Registration

Please fill out the form below to register for VBS. If you have more than one child attending, only one form needs to be completed (there is space below to list additional children). If you have any questions, please email us at [email protected].
*Please note: Children must be potty-trained in order to attend. Thank you for your understanding.

We look forward to seeing you!

Child Information

* Indicates required field

Name of Child Attending *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Allergies? *

Yes No

Allergy List *

Do you have additional children attending? *

Yes No

Names of other children attending: *

Allergies of additional children: *

Parent Information

Parent Name *

First

Last

Parent Phone Number *

Parent Email *

Parent Name *

First

Last

Parent Phone Number *

Parent Email *

Are you currently a member of a church? *

Yes No

If yes, what church do you belong to? *

Emergency Contact Information

Emergency Contact 1 *

First

Last

Emergency Contact 2 *

First

Last

Emergency Contact 1 Phone Number *

Emergency Contact 2 Phone Number *

Authorized Pickup Individuals

If I am unable to pick-up my child/children, I authorize the following individuals to pick them up from VBS: (Please note - St. John's will not allow any child to leave with anyone who is not a parent, or listed as an individual authorized for pickup) *

I acknowledge that all information is correct and accurate, and I release St. John's of any liability while my child/children is attending Vacation Bible School. *

I agree

Submit

VBS Registration

Location

St. John's Ev. Lutheran Church

621 North Vine Street
Hazleton, PA 18201

570-459-6423

[email protected]

VBS Registration

Location

​St. John's Ev. Lutheran Church621 North Vine StreetHazleton, PA 18201​570-459-6423​[email protected]

St. John's Ev. Lutheran Church

621 North Vine Street
Hazleton, PA 18201

570-459-6423

[email protected]