Connection Church Millen VBS
Please fill out your details to register for the upcoming vacation bible school. July 12-14 6:00-8:30 pm
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant's age
Grade the participant just completed *if applicable*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th 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 Medical Conditions
Additional Notes or Special Instructions
Register
Should be Empty: