VBS Registration | Como Park Lutheran Church, ELCA: Serving St. Paul, Falcon Heights and Roseville MN

Child's Name

First Last

Address*

Street Address City MN ZIP Code

Child's Age and Grade Completed*

E-mail address:

Phone*

Parent's or Guardian's Names:

Who is authorized to pick up your child/children:

Emergency Contact Name

First Last

Relationship to child:

Phone*

Address*

Street Address City MN ZIP Code

Does your child have allergies? If so, please explain:

Are you a member of CPLC?

If not, where did you hear about VBS at CPLC?