Child's Name
Birthdate
-
Month
-
Day
Year
Date
Age (must be at least age 3)
Grade Completed
Please Select
N/A
Gr K
Gr 1
Gr 2
Gr 3
Gr 4
Gr 5
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
T-Shirt Size
Youth XS
Adult S
Youth S
Adult M
Youth M
Adult L
Youth L
Adult XL
Email
example@example.com
Parent Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact (IN THE EVENT A PARENT CANNOT BE REACHED)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Name
First Name
Last Name
Does your child have allergies or medical conditions that we should be aware of?
*
Yes
No
If you answered YES, list below:
*
Do you give consent for photos or videos to be taken of your child for use on our website/social media?
Yes
No
How did you learn about our VBS?
I attend WBC
Postcard
Family/Friend
Flier
Facebook
Church Sign
Instagram
Text
Submit
Should be Empty: