BackTrinity Lutheran Church

Vacation Bible School

June 29, 2009 - July 3, 2009


Student's Name Gender Birthdate Grade (completed)

Allergies
         
         
         
         
         

 

Home Address _________________________________________________________________

Parent/Guardian Name(s) _________________________________________________________

Email Address_______________________________ Business/Cell Phone __________________

Other Emergency Contact _________________________Relationship __________Phone __________

Other Emergency Contact _________________________Relationship __________Phone __________

 

Mail to: Trinity Lutheran Church

149 Honness Lane

Ithaca, NY 14850