VBS Registration Form

June 14th-17th | VBS begins June 14th from 5:00–7:00 PM. Programs continue June 15th–June 17th from 8:00 AM–12:00 PM each day. Families are invited back on June 17th from 6:00–7:15 PM for a special closing celebration.

Main

Child's Information

Name

*

Gender

*

Please select one option.

Male Female

Age

*

Medical/Allergy Information

Does your Child have any allergies or medical information we need to be aware of?

*

Please select one option.

yes no

Medical/Allergy Information

Education

Grade

*

Please select one option.

Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Parent/Guardian

Name

*

Contact

Name

*

Phone

*

Email

*

This address will receive a confirmation email

Address

*

Mailing Address if different

Emergency Contact 1

Other than Parent/Gaurdian info above

Emergency Contact 1 Name

*

Emergency Contact 1 Number

*

Emergency Contact 2

Emergency Contact 2 Name

*

Emergency Contact 2 Number

*

Dismissal Information

Names That Are Able To Pick Child Up

*

Photography Release

May we have permission to photograph and use your child's photo from purpose of promotion?

*

Please select all that apply.

Yes No

Description

June 14th-17th

VBS begins June 14th from 5:00–7:00 PM. Programs continue June 15th–June 17th from 8:00 AM–12:00 PM each day. Families are invited back on June 17th from 6:00–7:15 PM for a special closing celebration.

Please Fix the Following

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