2019 VBS Registration
Mission 28:19 VBS
July 25th-27th: 5:30-8:00pm, Family Day: July 28th @ 10:30
Blendville Christian Church
2201 S Picher Ave. Joplin
Contact: Shaina Hicks, 573-480-0195
Child's Name [first and last] *
Your answer
Child's Date of Birth *
Your answer
Child's Date of Age *
Your answer
Grade Completed *
Your answer
Parent/Guardian Name [first and last] *
Your answer
Parent/Guardian Phone *
Your answer
Parent/Guardian E-mail Address *
Your answer
Street Address *
Your answer
Medical Issues/Special Needs/Other *
Your answer
Emergency Contact [Name, relation and phone number] *
Your answer
Adult Responsible for Pick-Up [Name, relation, phone number] *
Your answer
I agree that Blendville Christian Church & Children's Ministry can use any photos taken of/including my child in current or future use on website/email/social media/etc. *
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