Green Valley Evangelical Lutheran Church
1799 Wigwam Pkwy
Henderson, NV 89074
PH: (702) 454-8979
FAX: (702) 454-0528
© 2013

Online Registration Form

Please fill out the fields below to register for Vacation Bible School at Green Valley Evangelical Lutheran Church.

You may register up to three children on this form. Submit the form and fill out another form for additional children.

Enter your child's age on September 30, 2012 (Must be 4 years old by this date)

Amazing Desert Journey
August 6-10, 2012
9 am - Noon

T-shirt are free if the registration is received by July 22, 2012. Registrations received after this date are not guaranteed to receive T-shirts.

* Required Fields

*Parents' Name(s):
*Street Address:
*Zip Code:
*Phone:
Alternate Phone:
Church Affiliation:
*Email Address:
*Allergies (enter "none" if no allergies):
*Name of Child #1:
Child #1 Friend Request (to be in the same group):
*Age for Child #1:
*Grade Entering for Child #1:
Child #1 T-shirt size:
Name of Child #2:
Child #2 Friend Request (to be in the same group):
Age for Child #2:
Grade Entering for Child #2:
Child #2 T-Shirt size:
Name of Child #3:
Child #3 Friend Request (to be in the same group):
Age for Child #3:
Grade Entering for Child #3:
Child #3 T-shirt size:
Authentication:
9 + 0 = ?:	(Required) Enter the correct answer to the math question.
Please click the Send button only once.