VBS-Event

VBS Registration Information

* Indicates required field

Childs Full Name *

First

Last

Preferred Name *

Date of Birth *

Grade Completed *

Parent / Guardian Name *

First

Last

Parent / Guardian Phone *

Parent / Guardian Email *

Parent / Guardian Street Address *

Address City *

Zipcode *

Emergency Contact Name *

First

Last

Relationship to your child *

Emergency Contact Phone *

Medical Conditions / Allergies *

Medications *

I hereby Give the following Permissions *

For my child to participate For basic first aid or transport to medical facility For photos/videos to be taken for church media.

List any special considerations *

By Clicking Yes you consent to your child participating in VBS activities *

Yes No

Submit