Vacation Bible School Registration
VBS Dates: June 16 - 17, June 23 - 24, June 30 - July 1
Saturdays: 9:00 am - 12:00 pm
Sundays: 10:30 am - 12:00 pm

Email address *
Child's Name *
Your answer
Parent/Guardian's Name *
Your answer
Home Phone Number
Your answer
Cell Phone Number *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Last Grade Completed in School *
Medical Information - Medical information we need to know. (Please include any food allergies.)
Your answer
Emergency Contacts - Names & phone numbers *
Your answer
Dismissal Information - Who may pick up your child at the end of each VBS day? *
Your answer
Does your child attend Sunday School? If so, where?
Your answer
If your child is visiting our church, who is he/she a guest of?
Your answer
May we have permission to photograph your child? *
Required
May we have permission to use your child's photograph for the purpose of promotion? *
Required
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