VBS Registration

VBS will be held each Sunday June 12-July 10 (5p-7p)

* Indicates required field

Child's Name *

First

Last

Child's Birth Date *

Grade Completed during 2021-2022 School Year (students must have completed grades K-5th) *

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone *

Physical Address *

Line 1

Line 2

City

State

Zip Code

Country

Mailing Address if different than physical address *

Line 1

Line 2

City

State

Zip Code

Country

Home Number *

Alternate Number *

Permission for child's picture to be taken and published. *

Yes No

Medical or other information we need to know (Please include any food allergies) *

Name of Emergency Contact (Other than those listed above) *

Phone Number *

Please list adults other than parent or guardian authorized to pick up student? *

Does your child attend Sunday School? If so, Where? *

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

Submit