Theme image

Participant Registration

Go Back

Registro en Español

Faith Lutheran Church

Location

602 S. 14th St.

Adel, IA 50003

Map It

Contact DCE Madi Aeikens:

701-238-5222

dcemadi@faithadel.com

First, Tell Us About Yourself:

Parent Information

First Name

This field is required.

Last Name

This field is required.

Address 1

This field is required.

Address 2

This field is required.

City

This field is required.

State/Province

This field is required.

ZIP/Postal Code

This field is required.

Country

This field is required.

Contact Phone 1

This field is required.

Contact Phone 2

This field is required.

Emergency Contact Name

This field is required.

Emergency Contact Relationship

This field is required.

Emergency Contact Phone

This field is required.

Alternate Pickup Name

This field is required.

Alternate Pickup Phone

This field is required.

Home Church Affiliation

This field is required.

Comments

This field is required.

Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

(Must be 4 years of age by September 1 of 2024, completed one year of preschool, and potty trained)

First Name

This field is required.

Last Name

This field is required.

Current Grade

This field is required.

Gender

This field is required.

Date Of Birth

This field is required.

Allergies

This field is required.

Medical Concerns

This field is required.

Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

This field is required.

Friend 1 Last Name

This field is required.

Friend 2 First Name

This field is required.

Friend 2 Last Name

This field is required.

Friend 3 First Name

This field is required.

Friend 3 Last Name

This field is required.

Comments

This field is required.

Family Physician

This field is required.

Family Physicians Contact Number

This field is required.

While Faith Lutheran welcomes all children, we are unable to provide 1:1 assistance. Has your child received 1:1 assistance at school during 2023-2024 school year?

This field is required.

If yes, what is the contact name and number of the individual who will be attending VBS with your child?

This field is required.

By checking here, you agree to the following:

This field is required.

Do Not Send Your Child To VBS if They Have Been Sick In The Past 24 / 48 Hours

Code of Conduct: We reserve the right to contact the parent and, if necessary, send home any student who is disrespectful, uncooperative,
disruptive or in any way interferes with the learning experience of other students in his or her class.

Authorization of Participation: I have read and agree to abide by the above guidelines regarding attire
and conduct and hereby give permission for my child to participate in any activity or trips planned by the VBS staff and congregation.
I also authorize delivery of necessary emergency care by available medical personnel.

Appropriate attire No hats or caps. No flip-flops or similar footwear;
sneakers or similar sturdy shoes recommended. We are not responsible for injuries due to inappropriate footwear.

PHOTO NOTICE
Photos taken at this event may be publically displayed or used in promotional material by Faith Lutheran Church and Preschool. Please notify Faith Lutheran Church and Preschool or event organizers if you do not want a photo or video of you or your children to be displayed or used.

— or —