VBS Online Registration
Ages: 4yrs - 6th grade
Timing: June 5th-9th, 2017
Event Address: 2535 N Amidon Ave, Wichita, Kansas
Contact us at (316) 838-0400 or cbcoffice@cornerstonewichita.org
Child's First Name
Your answer
Child's Last Name
Your answer
Gender
Child's Birthday
MM
/
DD
/
YYYY
Grade completed
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Parent/Guardian First Name
Your answer
Parent/Guardian Last Name
Your answer
Email
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Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Emergency Contact
Your answer
Relationship to child
Your answer
Emergency Phone
Your answer
Please place my child with:
Your answer
Name of home church
Your answer
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