VBS Online Registration
Ages: K - 6th grade
Timing: June 3rd-7th, 2019
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 *
Include Year of Birth
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
Your answer
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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