Immanuel Lutheran Church, Grand Ledge, Michigan

VBS will be held July 26 - July 30, 2010 from 9:00 a.m. to 12:00 noon each day. All children 4 years old through 5th grade (completed) are welcome. There is no cost to register, but a freewill offering will be taken during the week.

Complete the following information and click the "Submit" button. To clear the form, click the "Reset" button at the bottom. To register more than 5 children, you'll have to return to the form a second time. A link on the confirmation page will allow you to return to this page once you've registered your first 5 children. Fields with a (*) are required to be completed.

Child 1
*Child1 First Name:
*Child1 Last Name:
*Child1 Date of Birth: (mm/dd/yy)
*Child1 Last Grade Completed:
Child 2
Child2 First Name:
Child2 Last Name:
Child2 Date of Birth: (mm/dd/yy)
Child2 Last Grade Completed:
Child 3
Child3 First Name:
Child3 Last Name:
Child3 Date of Birth: (mm/dd/yy)
Child3 Last Grade Completed:
Child 4
Child4 First Name:
Child4 Last Name:
Child4 Date of Birth: (mm/dd/yy)
Child4 Last Grade Completed:
Child 5
Child5 First Name:
Child5 Last Name:
Child5 Date of Birth: (mm/dd/yy)
Child5 Last Grade Completed:

*Parent's or Guardian's Name:
*Street Address:
Street Address:
*City:
*State:
*Zip:
*Primary Phone:
Secondary Phone:
Email:
Keep Email Private:
Current Church Affiliation:

*Emergency Contact Name:
*Emergency Contact Phone:

Allergies, Medical Concerns or Other Comments: