Registration Form
VBS Rocky Road (August 3rd - 7th)
821 SE M.L.K. Jr Blvd, Stuart, FL 34994
Daniel Jones Corps Youth Director (772) 266-8621
Email address *
Your Child’s Name *
Child’s gender: *
Child’s age: *
Date of birth: *
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Name of parent(s): *
Address: *
Home telephone:
Parent/caregiver’s cellphone:
Home church:
Allergies, medical conditions, or special needs:
In case of emergency, contact: *
A copy of your responses will be emailed to the address you provided.
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