Event registration VBS 2018
Event Date: July 22 - July 26, 2018
Event Time: 6:00-8:30 pm
Event Address: 2250 E. Stroop Rd., Kettering, OH 45440
Contact us at (937)298-6221
Child's Name *
Your answer
Child's Gender
Child's Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Last School Grade Completed
Your answer
Name of Parents/Guardian
Your answer
Address *
Your answer
Home Phone #
Your answer
Parent/Caregiver's Cell Phone#
Your answer
Home Email Address
Your answer
Home Church
Your answer
May we have permission to photograph your child?
May we have permission to use your child's photograph for the purpose of promotion?
Allergies or Medical Conditions *
Your answer
Does your child have any special needs that may require extra help? If so, please explain.
Your answer
In case of emergency, contact: (Include name & number)
Your answer
Relationship to Child
Your answer
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