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VBS Registration Form
Faith Community Church Fort Atkinson, WI
For questions, contact Jackie Lyon: (920) 563-4730
July 31 - August 4, 2023 - 9:00am to 12:15pm
For children ages 3 - Grade 6
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Parent/s Names
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Ex. Bob and Sally Smith
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Address
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City:
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State
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Please enter state as 2 digit code (WI)
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Zip Code
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Cell Phone:
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Please enter as: (XXX) XXX-XXXX
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Home Phone:
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Email:
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Will you be on the church campus during VBS?
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Yes
No
If you will be on church campus, where?
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VBS Volunteer
"Moments for Moms"
Not Applicable
In case of emergency, please contact:
Emergency Contact's First and Last Name:
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Emergency Contact's Relationship to child:
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Emergency Contact's Phone:
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Please enter as: (XXX) XXX-XXXX
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2nd Emergency Contact's First and Last Name:
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2nd Emergency Contact's Relationship to child:
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2nd Emergency Contact's Phone:
Please enter as: (XXX) XXX-XXXX
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