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Surfside Community Fellowship VBS '23
Preregister your child for our VBS, June 12-15 from 6-8pm. Only one child per form submission.
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* Indicates required question
Child's Full Name
*
Your answer
Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Guardian's Full Name
*
Your answer
Grade Level Completed
*
PreK
1st
2nd
3rd
4th
5th
6th
Is a sibling also attending VBS?
*
Yes
No
Address
*
Your answer
City
*
Your answer
State
*
Your answer
ZIP
*
Your answer
Primary Phone
*
Your answer
Secondary Phone
*
Your answer
Email
*
Your answer
Emergency Contact Full Name
*
Your answer
Emergency Contact Phone
*
Your answer
Allergies or Special Needs?
*
Yes
No
If so, what?
Your answer
Person Responsible for Pickup after VBS (if different from guardian)
Your answer
Pickup Person's Phone
Your answer
Pickup Person's Relationship with Child
Your answer
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