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Scuba VBS 2024 Registration Form
For children ages 5 through 12
June 23rd through 27th from 6-9pm
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* Indicates required question
Child's Name
*
Your answer
Child's Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Last school grade completed
*
Your answer
Name of Parent(s)
*
Your answer
Street Address (please include city, state, and zip code)
*
Your answer
Home telephone number
*
Your answer
Parent/caregiver's cellphone
*
Your answer
Home email address
*
Your answer
Home church
*
Your answer
Allergies or other medical conditions
*
Your answer
Emergency contact name
*
Your answer
Emergency contact number
*
Your answer
Emergency contact relationship to child
*
Your answer
Permission to photograph child and post online
*
Yes
No
At the end of each VBS night, will your child be picked up?
*
Yes
No
Who may pick up your child? (name & relationship)
*
Your answer
Will your child walk to and from VBS each night?
*
Yes
No
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