Pitsburg Trinity Lutheran Church

To Mars and Beyond Vacation Bible School kickoff event will be every WEdnesday evening from 6:00 - 8:00 pm from July 10 Thru August 7th.

Name of Parent or Guardian
Child's Name
Grade
Birthdate
Street Address
City
Zip
Parent's Email
Mom's Work Number
Dad's Work Number
Mom's Cell Number
Dad's Cell Number
Emergency Phone Number
Person to contact in case of emergency
Name and Phone of Preferred Doctor or Hospital
Facts about child's medical history, including alergies, medications, and physical limitations
Dietary Restrictions?
Permission to use photos and videos?	Yes No
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Thank You! Your child is now registered for our 2016 VBS, Barnyard Roundup!

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A Congregation of the Evangelical Lutheran Church In America (ELCA)