Vacation Bible School Registration
Event Timing: June 19-22, 2017 12:00 PM - 3:30 PM
Lunch is Provided at No Cost 12:15 - 12:30 PM // VBS is Free
Event Address: 400 S Main St., Juneau, WI 53039
Contact us at (920) 386-3313 or //
Email address
Child's First Name
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Child's Last Name
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Grade Next Year
Child's First Time Attending?
Parent (s) / Guardian Name (First and Last)
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Address (Street)
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Zip Code
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Phone Number (cell)
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Phone Number (home)
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Emergency Contact (Name)
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Emergency Contact Phone Number
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Names of those authorized for pick-up
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Known Allergies (Lunch and Snack are served everyday - at no cost to you or child)
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What days will you attend? Mon - Thurs 12:00 PM - 3:30 PM
How will your child arrive at VBS?
How will your child leave VBS?
I give permission for my child to be photographed for photos to be used for various publications.
How did you hear about us?
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A copy of your responses will be emailed to the address you provided.
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