VBS 2017 Registration
August 6th-9th from 6:15 - 8:30 PM.
1000 Bales Chapel Rd. Jamestown NC, 27282
Child's Full Name:
Your answer
Parent of Guardian's Full Name:
Your answer
Child's Date of Birth:
MM
/
DD
/
YYYY
Child's Age/ Grade (Just Completed):
Address:
Your answer
Phone Number:
Your answer
E-Mail Address:
Your answer
Please list any allergies:
Your answer
Does your child have an EpiPen?
Who is allowed to pick up your child?
Your answer
How did you find out about us?
During VBS we will also post pictures of the children and activities, please indicate below if we are allowed to post pictures of your child (No name or identifying information will be provided) on our website:
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms