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2024 VBS Student Registration
Students 3 years old to just completing 8th grade may be registered for the 2024 Agents of Change VBS for Berea Christian Church
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Agents of Change
Child's Name
*
Your answer
Gender
*
Male
Female
Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Last Grade Completed
*
Your answer
Allergies or Medical Concerns
*
Your answer
Parent/Guardian Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Home Email Address
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Emergency Contact Relationship to Child
*
Your answer
Photo Release:
*
Yes you may take pictures/videos of my child and post them on the church website and/or Facebook
No, you may not take photos or videos of my child and post them on the church website and/or Facebook
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