Online VBS Registration - West Linn Lutheran Church

Please enter the information in the following form to register your child for VBS. When you're finished, press the "Submit" button. To start over, press the "Reset" button. If you would like to register more than one child, simply enter the information for the first child, submit it, and click on the link that will appear to enter additional children. Please be assured that West Linn Lutheran treats all information you provide as confidential.

INFORMATION ABOUT YOUR CHILD
Child's First Name:
Child's Last Name:
Grade:
Age:
Medical Notes:	Please indicate any food allergies or important medical information about your child that we should know.
FAMILY INFORMATION
Parent's Name(s):
Address:
City:
State:
Zip Code:
Phone:
E-Mail Address:
Name(s) of person authorized to pick up child from VBS:
Home Church:	WLLC Another Congregation None
EMERGENCY INFORMATION
Emergency Contact:
Emergency Phone:
Medical Insurance Co.:
Medical Policy #:


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Copyright ©1999-2006, WLLC All Rights Reserved	20390 Willamette Drive, West Linn, Oregon 97068 Office: (503) 656-0110 · Fax: (503) 650-7936