JVBC VBS Enrollment Form

JVBC VBS Registration

June 22-25 10:00-1:30
Ages 4-11

Meet us at Illumination Station for the brightest week of the year. Kids will explore all the ways light brightens, illuminates, reflects, and reveals while discovering that Jesus is the light who brings hope to our world! From 10:00-1:30 on June 22-25
CHILD INFORMATION:
Child Name

First NameLast Name
Child Name

First NameLast Name
Child Name

First NameLast Name
Child Name

First NameLast Name
Birth Date

MonthDayYear
Birth Date

MonthDayYear
Birth Date

MonthDayYear
Birth Date

MonthDayYear
Grade child will enter in Fall 2027
Grade child will enter in Fall 2027
Grade child will enter in Fall 2027
Grade child will enter in Fall 2027
Shirt Size
Shirt Size
Shirt Size
Shirt Size
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
MEDICAL INFORMATION
Emergency Contact

First NameLast Name
Phone Number
Format: (000) 000-0000.
Medical Concerns
Should be Empty:

JVBC VBS Registration