Victory Lutheran Church Vacation Bible School (VBS) 2025

Registration Form (One form per family)

August 11-15, 2025 10:30am - 12:30pm
Church Phone: 403-527-5617

Andie Wirsch phone(coordinator) 780-902-6644
Address of VLC: 2793 Southview Dr SE, Medicine Hat, AB
Office hours are Monday - Thursday 9am -5pm

Child must be 5 years old as of August 11, 2025 to participate.

Early Bird fee: If paid by July 28 the fee is $25.00 per student (5-12years). The fee is $35.00 per student after July 28.

Parent or Guardian Name:

This address will receive a confirmation email

Cell phone and/or Home Phone

Address

Child(s) Name(s)

Age

In case of emergency, contact

Allergies or other medical conditions

Alberta Health Care #

Who is authorized to pick up child(ren). We WILL ask for ID upon pickup

Parent/guardian authorization to photograph/video child(ren) listed on this form

Yes No

Would your child like to be grouped with another child? Please provide name of other child

Home church

Payment options:

Cheque (made payable to Victory Lutheran Church with memo) E-Transfer (to office@victorylutheran.ca (note Cash- bring to office at VLC Online through this form

Payment

Parent/guardian signature

Date

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Victory Lutheran Church Vacation Bible School (VBS) 2025

Description

Please Fix the Following