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2025 PHCC VBS REGISTRATION
Event Timing: August 3rd - 7th   6:00 - 8:30pm
Event Address: 19433 W Frontage Rd, Raymond, IL 62560
Contact us at (217) 229-3074
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Pleasant Hill Christian Church Presents:
Childs Name *
Child's Address *
Childs Birthday *
MM
/
DD
/
YYYY
Child's Age Group. Grade This Fall *
What days of VBS will your child attend? *
Required
Parent/Guardians Name & Phone Number *
Emergency Contact Name, Phone Number & Relationship To Child *
Name Of Home Church *
Dietary Restrictions *
Does your Child have any allergies *
Please describe allergies:
Does your child have an EpiPen?
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Medical Concerns *
I hereby grant permission for PHCC to record sounds, images, or video of my child while attending this VBS program. Any of these recordings may be used for publicity purposes by Pleasant Hill Christian Church. *
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