VBS Registration Date of VBS: June 10-14
You can include two children on one form providing their parent/guardian/address info is the same.
Name of Child 1
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Child Last Completed as of May, 2024
Completed K-4
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Name of Child 2
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Child Last Completed as of May, 2024
Completed K-4
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Name of Parent or Guardian
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
-
Area Code
Phone Number
2nd Phone
-
Area Code
Phone Number
Email
example@example.com
Name of Emergency Contact
First Name
Last Name
Emergency Contact Phone
-
Area Code
Phone Number
Emergency Contact Relationship to Child(ren)
Mother
Father
Grandparents
Other
Child(ren) Will Be Picked Up By
Mother
Father
Grandparent
Other
May We Photograph Your Child(ren)? (for crafts, promotional purposes, Facebook)
Yes
No
Please List Food or Other Allergies/ Special Information Regarding Your Child(ren)
Are You a Member or Regularly Attend a Local Church?
Yes
No
Please Share With Us the Name of Your Church:
If you are interested in a t-shirt select "yes" or "no" from the dropdown box. T-shirts will be available before and during VBS while supplies last.
Please Select
Yes
No
Submit
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