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VBS will be held each Sunday June 12-July 10 (5p-7p)
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Indicates required field
Child's Name
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First
Last
Child's Birth Date
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Grade Completed during 2021-2022 School Year (students must have completed grades K-5th)
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Parent/Guardian Name
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First
Last
Parent/Guardian Email
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Parent/Guardian Phone
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Physical Address
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Line 1
Line 2
City
State
Zip Code
Country
Mailing Address if different than physical address
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Line 1
Line 2
City
State
Zip Code
Country
Home Number
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Alternate Number
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Permission for child's picture to be taken and published.
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Yes
No
Medical or other information we need to know (Please include any food allergies)
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Name of Emergency Contact (Other than those listed above)
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Phone Number
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Please list adults other than parent or guardian authorized to pick up student?
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Does your child attend Sunday School? If so, Where?
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If your child is visiting our church, who is he/she a guest of?
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Submit