AGAPE 1 VBS REGISTRATION FORM

Vacation Bible School Registration

Register a child for Vacation Bible School and share the details we need for check-in, pickup, and emergency contact.
Parent / Guardian Name*

First NameLast Name
Child’s Name*

First NameLast Name
Age: Gender Male Female
Relationship to Child?
Second Child’s Name

First NameLast Name
Age: Gender Male Female
Relationship to Child?
Third Child’s Name

First NameLast Name
Age: Gender Male Female
Relationship to Child?
Mailing Address*

Street Address

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com

Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pickup Person*

First NameLast Name

Any food allergies? * If yes, please explain. *
Any medical conditions? * If yes please explain. *
Signature*

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Vacation Bible School Registration