VBS Registration

June 18 -22, 2017 6:00pm-8:30pm | Please fill out this form and click submit.

VBS is for children Preschool (4 years old) through 5th grade. Please complete a registration form for each child attending VBS.

Child's Name

*

Age Group- Grade Completed

*

Please select one option.

Pre-School Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Parent/Guardian First Name

*

Parent/Guardian Last Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Home Church

Emergency Contact

*

Relationship to Child

*

Please select one option.

Parent/Guardian Grandparent Aunt/Uncle Friend/Neighbor

Phone

*

Child's Allergies or Medical Conditions

Description

June 18 -22, 2017 6:00pm-8:30pm

Please fill out this form and click submit.

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