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Lighthouse Bapt Ch VBS & Battlefield: Ludington 2015 Pre-Registration
Parent Information
Parents First Names:*
Parents Last Name(s):*
Home Phone:*
Emergency Contact Number:*
E-Mail:*
Valid e-mail is required
Child Information
Child`s First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
Choose a State
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California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Indiana
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:*
Gender:*
Select Gender
Male
Female
Age: 4-11 VBS
Select Age
4
5
6
7
8
9
10
11
Age: 12-19 Battlefield: Ludington
Select Age
12
13
14
15
16
17
18
19
Grade Entering*
Select Grade Entering
PK
K
1
2
3
4
5
6
7
8
9
10
11
12
Current Church Home:
By Checking this Box I give my permission for my Child listed above to attend VBS
By Checking this box I give my permission for my teen listed above to attend Battlefield Ludington
Need Bus Pick Up*
Choose a
Need Bus Pick Up
Yes
NO
By checking this box I give my permission for my Child listed above to attend ride the bus to LBA
Special instructions concerning my child:
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