VBS 2021 Registration Form
(Please complete and submit a form for each child)
First Name of Child *
Last Name of Child *
Age *
Last Grade Completed in School *
Street Address *
City *
State *
Zip Code *
Parent(s) or Guardian Name(s) *
Parent(s) or Guardian(s) Contact Phone Number *
Alternate Contact Phone Number *
Email Address *
Preferred contact method for communication and updates *
Required
Name and Phone Number for Emergency Contact (someone not attending) *
Family Church/Religious Affiliation *
Names of Adults Attending *
Total Attending for Your Family *
Dates We Plan to Attend *
Required
We will be taking pictures of VBS activities which may include your child. Do we have permission to use photographs of your child for uses such as bulletin boards, newspaper articles, church website, and church publications? *
Required
Parent or Guardian's Signature - (By typing your name in the response box below, you agree that is your signature of acceptance of the information stated on this registration form that you are submitting.) *
Date of Application *
MM
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DD
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YYYY
Submit
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