VBS 2023 Pre-Registration
Online Registration Form for VBS program running July 10-14, 2023 from 6pm-8pm
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E-mail address *
Parent or Guardian Name *
Address (street, city, zip) *
Phone Number *
Emergency Contact (name and phone number) *
Emergency Contact 2 (name and phone number) *
DISMISSAL INFORMATION
Anyone picking up your child(ren) MUST show Valid ID
Who may pick your child(ren) up at the end of VBS each night? (list all below) *
May we publish photographs with your child on our Church's Social Media accounts (Facebook, Instagram, etc.) *
CHILD'S REGISTRATION INFORMATION
PLEASE NOTE:  Children must be 4 years old or older (pre-k through 6th grade) and potty trained prior to 6/30/23 to register
Child's Name (first and last) *
Child's Age *
Child's Date of Birth *
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What Grade will this child enter in September? *
Special Needs (allergies, etc.)
Have you attended our VBS before?
Clear selection
REGISTER ADDITIONAL CHILDREN BELOW
PLEASE NOTE:  DO NOT include children from different families on one form. Please fill out a separate form for children outside of your home.
Child 2 Name (first and last)
Child 2 Age
Child 2 Date of Birth
MM
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DD
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What Grade will this child enter in September?
Clear selection
Special Needs (allergies, etc.)
Child 3 Name (first and last)
Child 3 Age
Child 3 Date of Birth
MM
/
DD
/
YYYY
What Grade will this child enter in September?
Clear selection
Special Needs (allergies, etc.)
Child 4 Name (first and last)
Child 4 Age
Child 4 Date of Birth
MM
/
DD
/
YYYY
What Grade will this child enter in September?
Clear selection
Special Needs (allergies, etc.)
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