VBS Registration Form

• Shepherd of the Hills Lutheran Church
• 246 Woodport Road
• Sparta, NJ 07871
• sothnjsundayschool@sothnj
• Church tel# 973-729-7010
• VBS Director: Nancy Wood 973-713-2462

Vacation Bible School 2025 – “Camp Chaos” July 7-11 9am-Noon

For 4-year-olds (able to toilet themselves) through 5th grade (completed)

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Child 1's name *

Child 1 Age *

Child 1 Grade (completed as of June '25) *

Child 1 Birthday *

Any medical issues (such as asthma, seizures, etc.) or food allergies or intolerances? *

Does your child carry an Epi Pen and know how to use it? *

Carry an inhaler? *

Child 2's name

Child 2 Age

Child 2 Grade (completed as of June '25)

Child 2 Birthday

Any medical issues (such as asthma, seizures, etc.) or food allergies or intolerances?

Does your child carry an Epi Pen and know how to use it?

Carry an inhaler?

Child 3's name

Child 3 Age

Child 3 Grade (completed as of June '25)

Child 3 Birthday

Any medical issues (such as asthma, seizures, etc.) or food allergies or intolerances?

Does your child carry an Epi Pen and know how to use it?

Carry an inhaler?

CONTACT INFORMATION: Parent/Guardian 1 Name *

or Child

Parent/Guardian 1 Cell phone *

Parent/Guardian 1 Email *

Parent/Guardian 2 Name

Parent/Guardian 2 Cell phone

Parent/Guardian 2 Email

Special concerns we should be aware of?

Do we have permission to photograph your child/children? *

• Yes
• No

May we use your child's/children's photograph in a slide presentation, church website, or Facebook page? *

• Yes
• No

EMERGENCY INFORMATION: *

EMERGENCY CONTACT OTHER THAN A PARENT (NAME, PHONE #)

DISMISSAL: Who may pick up your child/children at the end of the day? *

Name, relationship

Submit

Fee: $20/child or $50 per family maximum for 3 or more children within the same immediate family. Pay online by clicking on the “Pay via Vanco” button, using the QR code below with your phone, or via check (mail to church).

Pay via Vanco

EARLY REGISTRATION IS PREFERRED FOR PROPER PLANNING – THANK YOU!