St. Stephen's VBS Registration Form
The VBS program will be held Mon-Fri, July 10-21, 2017, for children ages 4-12. Please complete a form for EACH CHILD!
Email address
Child's Full Name
Your answer
Birthdate
MM
/
DD
/
YYYY
Last Grade Completed
Child will attend on the following days - 1st week
Please check off all that apply.
Required
Child will attend on the following days - 2nd week
Please check off all that apply.
Required
Allergies/Medical Conditions
Please write "none" if your child has no allergies or medical conditions.
Your answer
Parent/Guardian's Full Name
Your answer
Contact Phone
Your answer
Home Address
Your answer
Child may be released to - name & phone
Your answer
Emergency Contact - name & phone
Your answer
Media Release
Photographs and/or video in which my child appears can be used by the church in printed and/or electronic media, including the church's website and Facebook page.
Please complete the captcha before submitting the form.
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