VBXbox Child Registration
Online child pre-registration for VBXbox is now open! Please complete one online form for each child. Thanks!
Email address
Monday, June 12th - Thursday, June 15th 5:45pm-8:30pm
Child First Name
Your answer
Child Last Name
Your answer
Child's Gender
Child's Date of Birth
MM/DD/YYYY format
Your answer
Grade entering Fall 2017
Parent/Guardian Name
Your answer
Child's Mailing Address
Street Name
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Primary Phone Number
Your answer
Secondary Phone Number
Your answer
Church Affiliation
Your answer
Child's allergies or other medical information
Your answer
Emergency Contact Name
Someone Other than Parent/Guardian Listed Above
Your answer
Emergency Contact Phone Number
Your answer
Second Emergency Contact Name
Your answer
Second Emergency Contact Phone Number
Your answer
Is there anyone who may NOT pick up your child?
Your answer
Please list names of friends your child is attending VBX with:
Your answer
Please select below to give permission (or not) for Cumberland Community Church to use photos of your child from VBX for purpose of publicity, illustration, advertising and Web content.
If you would like to donate to VBX you can do so by:
Suggested donation is $10.00 per child.
Would you like to support VBX by volunteering?
Gift cards and Amazon Wish List items can be mailed to the church office at: Cumberland Community Church VBX, 3110 Sports Avenue, Smyrna, GA 30080.
A copy of your responses will be emailed to the address you provided.
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