Evangel VBS Registration Form
Child's Name *
Your answer
Child's Gender *
Your answer
Child's Age *
Your answer
Date of Birth *
Your answer
Last School Grade Completed *
Your answer
Name of Parent(s) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Parent Home Phone Number *
Your answer
Parent Cell Phone Number *
Your answer
Email Address *
Your answer
Are you a member of a local church? *
Church Name
Your answer
Does your child have any allergies or other medical conditions we need to be aware of? *
If you answered "Yes" above, please explain any allergy or medical condition you would like us to be aware of below.
Your answer
Emergency Contact Name and Phone Number *
Your answer
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