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VBS 2021 Registration
One form per child, please.
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Child's name
Your answer
Grade completed
Your answer
Birthday
MM
/
DD
/
YYYY
Age
Your answer
Parent's names
Your answer
Home address
Your answer
Home phone
Your answer
Alternate phone
Your answer
Emergency contact person
Your answer
Relationship to student
Your answer
Emergency contact home phone
Your answer
Emergency contact alternate phone
Your answer
Food allergies
Your answer
Medical concerns
Your answer
Family doctor
Your answer
Doctor's phone
Your answer
Siblings attending VBS (names and ages)
Your answer
Church affiliation
Your answer
Church membership at
Your answer
People who may pick up my child
Your answer
Transportation needed?
Yes
No
Clear selection
VBS Destination DIG t-shirt size ($10)
Choose
Youth XS
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
VBS leaders have permission to photograph/film the minor(s) designated above in any manner or form for any lawful purpose associated with this VBS program.
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