VBS Logo

VBS Registration Form
July 15-19
9 to 11:45 a.m.
Ages 4 through leaving 4th grade
Gethsemane Lutheran Church
409 E. Baldwin St.
Hackettstown, NJ 07840

Call, email or SIGN UP FOR VBS!
Please navigate the registration form using the "TAB" button.
When finished, click on the "SUBMIT FORM" button
To clear the form and start over, click on the "RESET" button."

Child's First name:
Child's Last name:
Child's Age:
Child's Date of Birth (yy-mm-dd):
Child's Last School Grade Completed:

Parent Name(s):
Street Address:
Home Phone:

Parent/Caregiver's Cell Phone:
Home Email Address:
Home Church:

Allergies or Other Concerns:
Emergency Contact Name:
Emergency Contact Relationship to Child:
Emergency Contact Phone:

Registration donation is $5 per child.