Vacation Bible School Registration

* Indicates required field

Parent/Guardian Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contacts (other than Parent/Guardian) *

Phone Number *

Adults authorized to pick student(s) up other than Parent/Guardian *

Student's Name *

First

Last

Date of Birth *

Grade Completed *

Medical Conditions/Allergies or other information we need to know. *

Student's Name *

First

Last

Date of Birth *

Grade Completed *

Medical Conditions/Allergies or other information we need to know. *

Student's Name *

First

Last

Date of Birth *

Grade Completed *

Medical Conditions/Allergies or other information we need to know. *

Does your Child attend Sunday School? If so where? *

If your child is visiting our church, who is he/she a guest of? *

May we have permission to photograph your child/children? *

YES NO

May we have permission to use your child's photograph for the purpose of promotion? *

YES NO

Submit

24063 LA HWY 16, DENHAM SPRINGS, LA 70726PHONE 225.665.6278