Participating Churches:

Holy Trinity Lutheran Church

Contact: Pr. Michelle Miller
Phone: 773.248.1233
Address: 1218 West Addison St.
             Chicago, IL 60613

Lake View Presbyterian

Contact: Pr. Larissa Kwong Abazia
Phone: 773.281.2655
Address: 716 West Addison Street              Chicago, IL 60613

Resurrection Lutheran Church

Contact: Pr. Brian Hiortdahl
Phone: 773.525.0605 x21
Address: 3309 N Seminary Ave.
             Chicago, IL 60657

LakeView Lutheran Church

Contact: Pr. Liala Beukema
Phone: 773.988.3958
Address: 835 West Addison Street
             Chicago, IL 60613

2010 VBS Registration Form

Registration Due by July 23, 2010

Parent/Guardian:
Email Address:     

Street Address:    
City: State: Zip:

Home Phone:
Cell Phone:     

Home Congregation:

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Number of Children Registering: 1 2 3 4

Child's Name:   Age:
Last Grade Completed: K 1 2 3 4 5 6 NA     

Child's Name:   Age:
Last Grade Completed: K 1 2 3 4 5 6 NA

Child's Name:   Age:
Last Grade Completed: K 1 2 3 4 5 6 NA

Child's Name:   Age:
Last Grade Completed: K 1 2 3 4 5 6 NA

Please list any allergies (including food allergies) the VBS staff should be aware of:

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In Case of Emergency (if parent/guardian cannot be reached):
Name:                       
Phone Number:            
Relationship to Child:  

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Comments, Questions, Concerns:

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Cost per child is $15. I will pay by:
Check (Payable to Holy Trinity Lutheran Church)
Online (After you submit this form, you will be given instructions as to how to pay online)