Vacation Bible School Sign-Up Form
Please provide your information below to register for Vacation Bible School at LifeGate! Details: Ages 4–11, July 6th – 10th, 6:00 PM – 8:30 PM. **Please complete a separate form for each child being registered.
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
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
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28
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31
Day
Please select a year
2021
2020
2019
2018
2017
2016
2015
2014
Year
Participant's Grade
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies or Special Needs
*
Photo Permission
Do you agree to your child being photographed and to those photos possibly being shared on social media?
*
I agree
I do not agree
Sign Up
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