Event registration
VALLEYVIEW VACATION BIBLE SCHOOL
Event Timing: August 4 & 5th, 2022 (6pm - 9pm)
Event Address: 410 N. Main St., Englewood, OH 45322
For questions: Contact us at Barbara.is.wise@gmail.com or call Barb Wise at 937-422-4691  
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Email *
First and Last Name of Parent *
Address *
Phone # *
Emergency Contact Name *
Emergency Contact Relationship to Child *
Emergency Contact Phone # *
First, Last Name of Child and Age *
First, Last Name of Additional Child and Age
First, Last Name of Additional Child and Age
First, Last Name of Additional Child and Age
Names and Phone numbers of people who are permitted to pick up child/children. *
Any food Allergies? *
If answered "Yes" to allergies - state name of child and kind of allergy. If answered "No", type NA. *
Do you give permission for VBS leaders to photograph/film the child/children designated above for any lawful purpose associated with this VBS program? *
I give permission for VBS leaders to change the diapers of the following child/children, who are not potty trained? (List First and Last names) *
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