About

VBS Registration Form

Sunday June 30 - Thursday July 3
9am to 12pm
Ages Pre-K to 6th grade

Child Registering

Child's Name:

Parent/Guardian's Name:

Street Address:

City:

State:

Zip Code:

Age:

Last Completed Grade:

Contact Information

Primary Phone:

Secondary Phone:

Email:

Medical Information:

Medical Information that we need to know (incl. Food Allergies):

Emergency Contact:

Phone:

Dismissal Information:

Name of person allowed to pick up child:

Phone:

Other Information:

Does your child attend church or Sunday School?:
Yes
No

If Yes, the name of Church:

Is your child visting our church?:
Yes
No

If Yes, who is your child a guest of?:

May we have permission to use your child's photo for promotional purposes?:
Yes
No