Lighthouse Bapt Ch VBS & Battlefield: Ludington 2015 Pre-Registration

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Parent Information

Parents First Names:*

Parents Last Name(s):*

Home Phone:*

Emergency Contact Number:*

E-Mail:*

Child Information

Child`s First Name:*

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Gender:*

Age: 4-11 VBS

Age: 12-19 Battlefield: Ludington

Grade Entering*

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*

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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