VBS Registration Form
Please fill out this registration form completely to let us know if your child will be attending VBS at Mt. Pleasant this year! Please fill out a separate form for each child. All information in this form is kept confidential!
What is your name? *
What is your Home address? (Please include City, State, and ZIP Code)
What is your child's name? *
How old is your child? *
What is your child's date of birth? *
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What is the last school grade your child completed? *
What is your home telephone number (Optional)
What is your cellphone number? (Parent, guardian, or caretaker) *
What is your home email address (Optional)
Do you have a home church already? (Optional)
Clear selection
If you answered yes to the above question, What is the name of your home church?
Does your child have any allergies, medical conditions, or special needs? If so please specify them. If not, type no. *
In case of an emergency who should we contact? Please list a name, their relationship to your child, and a phone number. *
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