VBS Registration
Dates July15th - 19th each evening from 6:30 - 8:30
Child's Name *
Your answer
Date of Birth *
Your answer
Current Age *
Your answer
Next School Grade *
Required
Parent/Guardian Names *
Your answer
Address 1 *
Your answer
City, State Zip *
Your answer
Phone *
Your answer
Home Congregation (Church name or NA) *
Your answer
Food Allergies (if none, respond "none") *
Your answer
Medical conditions we should be aware of *
Your answer
Emergency Contact (name and number) *
Your answer
Names of people authorized to pick up your child (NOTE: No one will be allowed to pick up your child whose name is not listed below. Changes can be made in an emergency by contacting the directors at (479) 531-9135 or (501) 733-2157) *
Your answer
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