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VBS Registration
August 2-6, 2021 9am-11:30am
Daytona Beach Drive In Christian Church
3140 S. Atlantic Avenue Daytona Beach Shores, FL 32118
386-767-8761
revmelissa@driveinchurch.net
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Email
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Child's Name/Grade Completed/Age (Please complete one registration/child)
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Complete mailing address (including zip code)
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Parent/Guardian Name & phone number
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Your answer
Can we communicate with you via text message?
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Do we have permission to use your child's photo on our social media posts/website
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Emergency Contact Name and cell phone #
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Special Needs/Allergies we should be aware of
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Name/relationship/Cell # of person authorized to pick up your child
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