Vacation Bible School registration - Aug. 2022
Event Timing: August 2,3,4 from 5:30-7:30p.m.
Event Address: 1100 N. Calhoun Street, West Liberty, IA  52776
Contact us at (319) 627-2989 or
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Email *
Name of child *
Primary Parent contact's name *
Primary contact's email address *
Additional adult authorized to pick up your child
Secondary email address
Secondary phone number
Child's date of birth
Child's shirt size - in youth sizes
Any Allergies? *
Child's grade in school fall of 2022 *
Any special needs or concerns you would like to share regarding your child?
I give my permission for my child to have his/her picture taken for items such as our church website, brochures, Facebook, the West Liberty Index. *
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