2021 VBS Registration
Please complete this form for EACH student who will attend VBS
Child's Name *
Child's Age *
Most Recent Grade Level *
Street Address *
City *
State *
Contact Phone Number *
Contact Email
In case of emergency, contact *
Emergency contact phone number *
Allergies, special medical needs or other conditions we should know about?
Home Church
Do you give us permission to use photos/videos of your child on our church website and/or social media site? *
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This form was created inside of Surry County Schools. Report Abuse