Church Radiant VBS Registration
Please fill out this form and e-sign the waiver to confirm your registration at Church Radiant's Vacation Bible School. We cannot wait to see you!

If you have questions, please email us at churchradiant525@gmail.com
Email address *
Child's Name (First and Last) *
Your answer
Grade entering, September 2019 *
Parent Name *
Your answer
Parent Phone Number *
Your answer
Address *
Your answer
Do you attend a local church? If so, which one? *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Allergies or medical needs we need to be aware of (please include food allergies) *
Your answer
Medical Insurance and Provider *
Your answer
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