Vacation Bible School - June 16-20
Fill out the form carefully for registration
Student Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2019
2018
2017
2016
2015
2014
2013
2012
2011
Year
What Grade Was Just Completed? NOTE: Must Have COMPLETED Kindergarten
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
First Name
Last Name
Parent Phone Number
*
Parent E-mail
example@example.com
Will Your Child Join Us For Dinner at 5:30?
*
Does Your Child Have Any Allergies We Should Be Aware Of? Please Be Specific
Where Do You Attend Church?
Name of Church
Additional Comments
Submit
Should be Empty: