DVBS Registration Form

DVBS 2026 REGISTRATION
Student Information
Child's Name

First NameLast Name
Child's Age
Child's Nick Name
Birth Date

MonthDayYear
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/ Guardian Information
Name

First NameLast Name
Phone Number
Format: (09) 000-000-000.
Facebook/ Messenger:
Emergency Information
Allergies or Medical Condition of your Child:
Who Should we contact in case of Emergency?

First NameLast Name
Phone Number
Format: (09) 000-000-000.
Who Should we contact in case of Emergency?

First NameLast Name
Phone Number
Format: (09) 000-000-000.
After School Pick Up

Who may pick up your child at the end of each VBS day?
Name
Relationship
Name
Relationship
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Km. 4 Asin Road Christian Church for the DVBS 2026.
Date

MonthDayYear
Date
Should be Empty:

Student Information