VBS Online Registration
Ages: 4yr.-6th grade
Timing: June 7th-11th, 2021
Event Address: 2535 N Amidon Ave, Wichita, Kansas
Contact us at (316) 838-0400 or cbcoffice@cornerstonewichita.org
Child's First Name *
Child's Last Name *
Gender *
Child's Birthday *
Include Year of Birth
MM
/
DD
/
YYYY
Grade completed *
Address *
City *
State *
Zip *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Email
Home Phone
Work Phone
Cell Phone
Emergency Contact *
Relationship to child *
Emergency Phone *
Please place my child with:
Name of home church
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