VBS Registration Form

Child's Name *
Child's Name
Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
Primary Phone Number *
Primary Phone Number
Secondary Phone Number
Secondary Phone Number
Birth Date *
Birth Date
Child's Date of Birth
Medical or other information we need to know.
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Who may pick up your child at the end of VBS each day?
May we have permission to photograph your child? *
May we have permission to use your child's photograph for the purpose of promotion? *
5th/6th Grade Only: My child has permission to leave church grounds by bus for mission trips.