Splash Canyon

VBS Registration Form
July 30th-August 3rd
9 to 11:45 a.m.
Ages 4 through 4th grade (just finished)
Gethsemane Lutheran Church
409 E. Baldwin St.
Hackettstown, NJ 07840
908-852-2156
gethsemanehtown@gmail.com

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:
City:
State:
Zip:
Home Phone:

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

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


Registration donation is $5 per child.