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VBS Registration - July 11-15
Please complete all information for the safety of your child. VBS is from 9:00 - 12:00 for children 3 years through 6 grade.
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
Child's Last Grade in School
*
3 Years Old
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Or Preschool
Other:
Required
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Address 1
*
Your answer
Address 2
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Cell Phone
*
Your answer
Emergency Number
*
Your answer
Medical Information - Medical information that we need to know. Please include any food allergies. If none write "None."
*
Your answer
Who may pick up your child? List all names that are authorized if different from parent or guardian.
Your answer
Does your child attend a Sunday School?
Yes
No
Clear selection
May we have permission to photograph your child?
*
Yes
No
May we have permission to use your child's photograph for the purpose of promotion?
*
Yes
No
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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