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VBS Registration
Sunday, July 30th through Thursday, August 3rd.
5pm Dinner
6pm-8:30pm- Program
Offered for those leaving Kindergarten through leaving 5th grade
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Child's First Name
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Your answer
Child's Last Name
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Your answer
Child's Birthdate
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MM
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DD
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YYYY
Grade Completed
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Choose
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
kindergarten
Child's Gender
Female
Male
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Guardian First Name
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Guardian Last Name
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Address
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Number and Street
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City
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State
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New Jersey
Pennsylvania
Delaware
Other:
Zip
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Mailing Address (if different than above)
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Phone Number
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Alternative Phone Number
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Email
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Emergency Contact First
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Emergency Contact Last
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Emergency phone number
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Any Known Allergies
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Any Medical Concerns
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Pick-up person
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Your answer
Pick-up person's phone number
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Relationship
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Your answer
Do you agree to allow photos of your child to be used in church presentation or church promotional materials?
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