VBS Registration Form

VBS Registration Form

June 26-30, 2023 First Church DeLand 115 E Howry Ave
Student Name*

First NameLast Name
Age (Must be 4 by June 26)*
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Phone Number
Work Number
In case of emergency, Contact      *
their name is   First Name*   Last Name*
at this phone number   Area Code*   Phone Number*
Grade (Entering Fall 2023)*
Name of Home Church*
Known Allergies or Other Medical Conditions*
Should be Empty: