Peoria Church VBS Registration
Child 1 Name *
Your answer
Child 1: Grade entering *
Child 2 Name
Your answer
Child 2: Grade entering
Child 3 Name
Your answer
Child 3: Grade entering
Child 4 Name
Your answer
Child 4: Grade entering
Parent(s)/Guardian(s) Name *
Your answer
Parent/Guardian Phone *
Your answer
Street Address *
Your answer
City/State/Zip *
Your answer
E-mail Address *
Your answer
Emergency Contact Name (other than parent) *
Your answer
Emergency Contact Phone # *
Your answer
Allergies or other medical conditions
Your answer
VBS Adult Staff have my permission to transport my child to and from off-site VBS activities. (required for 5th-6th grade students to participate in service opportunities) *
I give my permission for the use of photos and videos including my son or daughter to be used on Peoria Christian Reformed Church's website. *
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