BSLC Member Information Form

Member Information Form
Blessed Savior Lutheran Church
Please fill out this form and return to the church office – thanks!

Name (required)

Address (required)

City & State (required)

Zip Code (required)

Home Phone (required)

Cell Phone (required)

Work Phone (if applicable)

Birth Date (YYYY-MM-DD format) (required)

City & State (required)

Age (required)
—Please choose an option—456789101112131415161718

Second Child's Name

Birth Date (YYYY-MM-DD format)

Age
—Please choose an option—456789101112131415161718

Parent Contact Information

Parent/Guardian Name (required)

Address (required)

E-mail (required)

Phone numbers -- please include area code if other than 618

Home Phone (required)

Cell Phone (required)

Cell Phone 2

Medical or other information

Medical or other info we may need to know (please include any food allergies) (required)

Emergency Contacts

Name of Emergency Contact(s) (required)

Phone Number (required)

Dismissal Information

Who else may pick up your child at the end of each VBS day? (required)
enter name(s) or n/a here

Supplemental Information

Do you attend Sunday School?
YesNo

If so, where?

Is there a friend your child would like to be put in a crew with?

May we have permission to photograph your child?
YesNo

May we have permission to use your child's photograph for the closing sessions?
YesNo

Special Requests or Additional Information

Thank you for completing our online signup!