VBS Registration
June 9-13, 2024 6:00-8:30p.m
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age on June 9, 2024
*
Shine VBS is open to children who are 5 years old and have completed Kindergarten through the completion of 5th grade.
Grade Completed
*
Please Select
K
1st
2nd
3rd
4th
5th
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
Relationship to the child
*
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Two Emergency Contacts(Information needed: name, number, relationship to the child)
*
Please list any allergies below:
*
If none, please type NONE
Special needs/any additional information that you would like us to know about your child:
Siblings also attending VBS:
Are there any additional adults authorized to pick up your child?
All authorized pick ups must be in writing. If you need to add an additional pick up during VBS please see a Heritage Church staff member or registration volunteer.
One last thing, how'd you hear about SHINE VBS at Heritage Church?
If your child was invited to VBS by a friend please list above.
Submit
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