Courageous Virtual VBS Registration Form

Courageous: Path to Freedom

Fort Rucker Religious Education Fort Rucker, Al 36362 Virtual Intergenerational VBS Age Guidelines K-6th Grade, 7th-12th Grade
Parent’s Name

First NameLast Name
Parent’s Name

First NameLast Name
Child's Name

First NameLast NameAge
Child's Name

First NameLast Name Age
Youth’s Name

First NameLast NameAge
Youth’s Name

First NameLast Name Age
Primary Contact's Email Address
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please list any special needs or concerns you would like to share regarding your child or teen?
Are you a first time visitor? If not, which service do you currently attend? Are you interested in receiving more information about virtual services?
Permission to photograph my child?
Parental Consent to Participate in VBS.
Parent’s Digital Signature
Should be Empty:

Courageous: Path to Freedom