VBS Registration

Please fill out the form below to register your child for VBS.

For a printable version of the form, click here.

Parent/Guardian Name
Child's Name
Email Address
Home Telephone
Work Telephone
Cell Phone
Address (street, city, state, and zip)
Mailling Address (if different)
Child's Birthdate
Last grade completed in school
Medical or other information we need to know. (Please include any food allergies.)
Emergency Contact #1 Name
Emergency Contact #1 Phone Number
Emergency Contact #2 Name
Emergency Contact #2 Phone Number
Who may pick up your child at the end of VBS?
Do you attend Sunday School?	Yes No
If yes, where do you go?
If you are visiting our church, who are you a guest of?
May we have permission to photograph you child?	Yes No
May we have permission to use your child's photo in church publications for the purpose of promotion?	Yes No
Your Questions or Comments