Puckety VBS Registration Form
June 18-22 6:00-8:45pm
Email address *
Child's Name *
Your answer
Gender *
Child's Age *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Last Grade Completed *
Parent/Guardian Name *
Your answer
Home Address *
Your answer
Phone Number (Cell) *
Your answer
Alternate Phone *
Your answer
Allergies or Medical Info (Please list/explain) *
Your answer
Photo Release: Pictures taken during VBS can be put on our church website (no names/just pictures) *
Home Church
Your answer
Crew Name/Number (Church use only)
Your answer
Submit
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