VBS Registration

Please fill out ONE form for EACH child.

Looking forward to seeing you at VBS!

Child's Name

Parent/Guardian Name(s)

Street Address

City

Zip

Mailing Address (If different from above)

City

Zip

Home Phone

Cell Phone

Email

Birthdate

Age

Last Grade Completed

Do you attend church?

If Yes, where?

Please provide two emergency contacts for your child.

Who has permission to pick up your child?

Are there any medical issues, including food allergies, that we should be aware of?

Do we have permission to photograph your child?

How did you hear about our VBS?