City Church - VBS Registration 2021
Thank you for taking the time to fill out the following registration forms. We look forward to having your child join us this summer. Please don't hesitate to call if you have any questions or concerns.

City Church
1680 Sparksford Dr.
Russellville, AR 72801
479-967-5882

VBS
June 28th - July 2nd
9:00 - 12:30
Ages 3 y/o (potty trained) - 6th grade
(Grade just completed)

Email *
Student name *
Gender *
Student age *
Last school grade completed *
Allergies or other necessary medical information (If none, write "none") *
Please list any current medications (If none, write "none") *
Parent name *
Cell phone number *
Home phone number
Which number is best to reach you? *
Address *
City *
State *
ZIP Code *
Home church
In case of emergency, contact *
Emergency contact phone number *
Emergency contact relationship to child *
City Church has my permission to photograph/film the minor designated above to be used for future promotional material via social media and/or church website. *
By checking the box below, you are giving your digital signature that the above information is correct and that your child has permission to attend vacation bible school at City Church. *
Required
Enter today's date below: *
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