2019VBS (Vacation Bible School)

2019 VBS (Vacation Bible School)
June 10-13, 2019
Registration Form for Pre-K through 5th Grade

Children

* Indicates required field

Child1 Name *

First

Last

Child1 Date of Birth *

Child1 Age *

Child1 Last school grade completed *

Child2 Name *

First

Last

Child2 Date of Birth *

Child2 Age *

Child2 Last school grade completed *

Child3 Name *

First

Last

Child3 Date of Birth *

Child3 Age *

Child3 Last school grade completed *

Home Church *

Allergies/Medical Information/Other *

Parent/Gaurdian

Parent/Guardian Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Numbers

Primary Phone *

Cell *

Work *

Emergency Contacts

Name Emergency1 *

First

Last

Emergency1 Phone Number *

Name Emergency2 *

First

Last

Emergency2 Number *

Name(s) of person(s) who may pick up this child from VBS :

Authorized Names *

Other Information (church use only)

Are parents helping with VBS? *

Yes No

If so, where? *

Submit