VBS 2024 - Participant Registration

MonthDayYear
Today's Date

MonthDayYear
VBS 2024
Participant Registration

June 17-21, 2024
9am-12pm, Mon-Thurs

9am - 12:15pm, Fri
General Information
Number of Children You Are Registering*
- Child #1
- Full Name*
  
  First NameLast Name
- Birth Date:*
  
  MonthDayYear
- Age:
  as of VBS start date
- School Grade (next year!)
  as of Sept. 2022
- MaleFemale
- Child #2
- Full Name*
  
  First NameLast Name
- Birth Date:*
  
  MonthDayYear
- Age
  as of VBS start date
- School Grade (next year!)
  as of Sept. 2022
- MaleFemale
- Child #3
- Full Name*
  
  First NameLast Name
- Birth Date:*
  
  MonthDayYear
- Age
  as of VBS start date
- School Grade (next year!)
  as of Sept. 2022
- MaleFemale
- Child #4
- Full Name*
  
  First NameLast Name
- Birth Date:*
  
  MonthDayYear
- Age
  as of VBS start date
- School Grade (next year!)
  as of Sept. 2022
- MaleFemale
- Child #5
- Full Name*
  
  First NameLast Name
- Birth Date:*
  
  MonthDayYear
- Age
  as of VBS start date
- School Grade (next year!)
  as of Sept. 2022
- MaleFemale
- Child #6
- Full Name*
  
  First NameLast Name
- Birth Date:*
  
  MonthDayYear
- Age
  as of VBS start date
- School Grade (next year!)
  as of Sept. 2022
- MaleFemale
- Parent/Guardian Info:
- Full Name*
  
  First NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Home Phone*
  Format: (000) 000-0000.
- Work Phone
  Format: (000) 000-0000.
- Cell Phone
  Format: (000) 000-0000.
- E-mail*
- Medical/Allergy/Emergency Contact Information
- Medical Conditions:
  Any medical conditions about your child that will help us should an emergency occur.
- Known Allergies:
  Any known allergies that your child has that will help direct us in making decisions for your child.
- Special Needs:
  Does your child have special needs? If so please specify.
- Other Helpful Info:
  Any other helpful medical or behavioral conditions about your child that will be helpful to us, or anything you want us to know.
- Emergency Contact Name #1:*
  
  First NameLast Name
- Emergenct Contact Phone #1:*
  Format: (000) 000-0000.
- Yes
- Emergency Contact Name #2:
  
  First NameLast Name
- Emergenct Contact Phone #2:
  Format: (000) 000-0000.
- Authorized Pickup Person(s)
- Yes
- Yes
- NAME: Authorized Pickup #1*
  
  First NameLast Name
- Relationship to Participant (Authorized Pickup #1)
- PHONE: Authorized Pickup #1*
  Format: (000) 000-0000.
- NAME: Authorized Pickup #2
  
  First NameLast Name
- Relationship to Participant (Authorized Pickup #2)
- PHONE: Authorized Pickup #2 *
  Format: (000) 000-0000.
- NAME: Authorized Pickup #3
  
  First NameLast Name
- Relationship to Participant (Authorized Pickup #3)
- PHONE: Authorized Pickup #3*
  Format: (000) 000-0000.
- NAME: Authorized Pickup #4
  
  First NameLast Name
- Relationship to Participant (Authorized Pickup #4)
- PHONE: Authorized Pickup #4*
  Format: (000) 000-0000.
- Church Affiliation
- Church Member status:
- Church Affiliation:
  Name of home church (if any)
- Guest Of: (optional)
  
  First NameLast Name
- Yes, I give permission for my child's picture to be usedNo, I do not want my child included in any pictures
- Monday, 06/17/2024, 9am-12pmTuesday, 06/18/2024, 9am-12pmWednesday, 06/19/2024, 9am-12pmThursday, 06/20/2024, 9am-12pmFriday, 06/21/2024, 9am-12:15pm
- ChurchOutdoor SignWebsiteFacebookFriendOther
- Comments/Questions
- Should be Empty: