Vacation Bible School Participant Registration
Please answer all questions completely.  Use a new form for each child.
Refunds will not be issued after June 30th, 2022
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Child's Last Name *
Child's Middle Name *
Child's First Name *
Child's Preferred Name for NAME TAG *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Child's Age as of July 18, 2022 *
Grade Child will be entering in the Fall of 2022 *
Street Address *
City
Zip Code *
School Child Attends *
Email Address *
Additional Email Address *
Mother's Last Name
Mother's First Name
Mother's Phone Number *
Can this child be released to their mother? *
Father's Last Name *
Father's First Name *
Father's Phone Number *
Can this child be released to the father? *
Allergies *
Please be specific.  If none, type NONE
Medical Conditions *
Please be specific.  If none, type NONE
In Case of Emergency Contact (Other than Parent) *
Name and Relationship
Emergency contact phone number *
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