VBS Registration

Hidden

Child's Name (click the + to add additional children):(Required)

First Name

Last Name

Child's Name(Required)

First Last

Parent/Guardian Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address (if different)

Street Address Address Line 2 City State ZIP Code

Phone - Cell(Required)

Phone - Home

Phone - Work

Email(Required)

Child's Birth Date(Required)

Last grade completed in school:(Required)

Medical or other information we need to know (please include any food allergies):

First Emergency Contact: Name(Required)

First Last

First Emergency Contact: Phone(Required)

Second Emergency Contact: Name

First Last

Second Emergency Contact: Phone

Who may pick up your child at the end of each VBS day?(Required)

Do you attend Sunday School? If so, where?(Required)

If you are visiting our church, who are you a guest of?

May we have permission to photograph your child?(Required)

Yes

May we have permission to use your child's photograph for the purpose of promotion?(Required)

Yes

This field is for validation purposes and should be left unchanged.