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Palm Springs SDA VBS 2021
Registration Form. Please complete one form for each participant.
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Age
*
0-1
2
3
4
5
6
7
8
9
10
11
12
13
14
Required
*
MM
/
DD
/
YYYY
Last Grade Completed
*
Choose
pre school
kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
NA: Infant or toddler
Child's Gender
*
Female
Male
Parent or Guardian's Name
*
Your answer
Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Mailing address if different from home address
Your answer
Cell Phone Number
*
Your answer
Secondary telephone number
*
Your answer
email address
*
Your answer
Home Church
*
Your answer
Mailing address, if different from above
*
Your answer
Emergency contact and phone number
*
Your answer
During VBS, we take photographs of children for closing celebration, newsletter and promotional purposes. Do you agree to have your child's photo included?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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