Registration Form

Registration form for Vacation Bible School
June 3-7, 2019
6 to 8:30 PM
Holy Cross Lutheran Church
2200 Third Ave.
Dodge City, KS 67801
620-227-6204

* Indicates required field

Adult Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Emergency Contact Phone Number *

Email *

Please provide your kid(s) name, age, and current grade in school *

Pleas list any food allergies your child/children may have. *

Will someone other than you be responsible for bringing your child/children? *

Yes No

If yes, please provide the name and contact information for this person. *

Is transportation needed? *

Yes No

Can you provide transportation in your area? *

Yes No

Submit