Parkside's Vacation Bible School
July 16-July 18 - Register each three year old - 6th grader SEPARATELY.
VBS- The Incredible Race!
Child's First Name *
Your answer
Last Name *
Your answer
Home Address *
Your answer
Zip Code *
Your answer
City *
Your answer
Date of Birth *
MM/DD/YYYY
Your answer
Home Phone *
(XXX) XXX-XXXX
Your answer
Cell Phone
(XXX) XXX-XXXX
Your answer
Email Address *
Your answer
Parents Names *
Your answer
Parent(s) Work Phone
Your answer
Emergency Contact Information *
Please provide name & number
Your answer
Allergies or Medical Conditions we should be aware of
Your answer
Age/ School Grade Completed *
Do you grant permission for Parkside Church of the Nazarene to use pictures of your child on its website and social media for informational or promotional purposes. *
Are there any days you know your child will NOT be able to attend VBS?
Check all that apply
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