2019 VBS Registration July 15-18 (please fill out a registration for each child)
Email address *
Monday-Wednesday, 6:00-8:00 PM
Child's First Name: *
Your answer
Last Name: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Last Grade Completed (select from dropdown list): *
Name of Parent(s) or Guardian(s): *
Your answer
Parent(s) phone #: *
Your answer
Street Address: *
Your answer
City:
Your answer
State:
Your answer
Home Church:
Your answer
Who will drop-off & pick up your child? (include Name & phone # for contact):
Your answer
Child's Allergies or other medical conditions:
Your answer
Any special instructions/limitations?
Your answer
In Case of Emergency, who should we contact: *
Your answer
Emergency Contact's phone: *
Your answer
Emergency Contact's Relationship to Child: *
Your answer
Is there any additional information that we may need to know?
Your answer
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