VBS Registration

Sign Up Your Child for VACATION BIBLE SCHOOL Wednesday Nights

June 17 and June 24 from 5pm - 7pm

* Indicates required field

Child's Name *

First

Last

Parent/ Gaurdian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Phone: Home *

Cell Phone *

Work Phone *

Email *

Age and Last Grade Completed: (Ages 4 yrs to 6th grade) *

Medical Information/ Allergies: (Please inform us of medical information we may need to know.) *

Emergency Contacts - other than the gaurdian listed above. Name and Phone. *

Dismissal Info: Who may pick up your child at the end of VBS? *

Other: Does Your Family Attend a Church? If so, where? *

Do we have your permission to photograph your child? *

Yes No

May we have permission to use your child's photograph for the purpose of promotion? (Example: VBS Photos on our Website). *

Yes No

Submit