VBS Registration

VBS Registration Form

* Indicates required field

Child's Name *

First

Last

Church Affiliation: *

Parent Name *

First

Last

Do you give permission to have photographs of your child to be included in VBS or Church Event Photos? *

Yes No

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Age Information

Grade just finished *

Age *

Medical Information

Does your child have any medical or other information we need to know? *

Yes No

If so, please list below *

Emergency Contacts (other than listed above)

Name *

First

Last

Phone Number *

Authorized Pickup 1 *

First

Last

Authorized Pickup 2 *

First

Last

Submit