VBS Registration - July 10-14
Please fill out the form completely.
Student Name
First Name
Last Name
Age (as of July 8)
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent/Guardian E-mail
example@example.com
Emergency Contact
Home Number
Work/Mobile Number
Approved Adult(s) For Pickup
Allergies, Medical Alerts, or Activity Restrictions
How did you hear about VBS?
What church do you normally attend?
Any Other Information for us?
Register My Child
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