2019 VBS Registration
@ Elim Mission Church. July 28 - 31, 5:30p - 8:00p, ages 4 years through 6th grade.
Child's Name *
Your answer
Child's Gender *
Child's age and birthdate *
Your answer
Last grade completed *
Your answer
Name of Parent(s) or Guardian *
Your answer
Address (Street, PO Box, City, State, Zip) *
Your answer
Phone Number(s) *
Your answer
Home Email Address *
Your answer
Home Church
Your answer
Allergies or other medical conditions *
Your answer
In case of emergency, contact: *
Your answer
Emergency contact phone *
Your answer
Relationship to child *
Your answer
I release Elim Mission Church from any liability due to accident while attending Elim's VBS *
Required
Photo Release: I give permission for pictures taken of my child during the week to be used in future Elim Mission publications and publicity *
Required
Do you have another child to register? *
Next
Never submit passwords through Google Forms.
This form was created inside of Elim Mission Church. Report Abuse - Terms of Service