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Vacation Bible School Registration
(One per child) Children must be 4 years old through 5th grade to attend.
VBS will be taking place every Sunday this summer during the 11AM service. (11AM-12:30PM)
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* Indicates required question
Child's Name
*
Your answer
Child's Gender
*
Option 1
Option 2
Child's Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Last school grade completed (if applicable)
Your answer
Parent(s) Names
*
Your answer
Address (include city, state, and zip code)
*
Your answer
Home Phone
*
Your answer
Parent/Caregiver's cellphone
*
Your answer
Email address
Your answer
Home church
Your answer
Allergies, medical conditions, or special needs
Your answer
In case of an emergency, contact
*
Your answer
Emergency contact phone number
*
Your answer
Emergency contact relationship to child
*
Your answer
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