2024 VBS Registration Form
Please complete a new form for each participant.
Participant's Name
*
First Name
Last Name
Participant's Birth Date
*
-
Month
-
Day
Year
Date
Participant's Gender
*
Participant's T-Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Youth XXL
Adult Small
Adult Medium
Adult Large
Adult XXL
Grade Completed & Age
*
Parent's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent's Cell Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent's Email
*
example@example.com
Emergency Contact's Name
*
First Name
Last Name
Emergency Contact's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact's Relationship to Child
*
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
*
List adults authorized to pick up your child and their relationship to the child. (John Doe - neighbor)
In the event it is not a parent, please note a valid I.D. will be required at sign-out.
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
A light supper will be served each night at 5:30 pm. Will you attend? For no, put zero, or put the number of people that will join us for supper.
*
How did you hear about VBS?
*
Would you be interested in learning more about any of the following opportunities coming up? Select all that apply.
2024-2025 School Year with the Roanoke SDA Church School
Soap Making 101 Class
Cooking Classes to Reverse Chronic Disease
Bible Studies
Submit
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