This Year’s VBS is JUNE 5,6,7
from 6-8:30 pm nightly.

PLEASE COMPLETE A SEPARATE REGISTRATION FOR EACH CHILD WHO IS ATTENDING!
⤵️

Parent First Name

Parent Last Name

Email

Best Phone Number to reach you:

CHILD First Name

CHILD Last Name

GENDER
Boy
Girl

Child’s age:

Child’s Date of Birth:

Last School Grade Completed:

Child’s Home Church:

Please list any allergies, medical conditions, or special needs we need to know:

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Relationship to Child:

This Year’s VBS is JUNE 5,6,7from 6-8:30 pm nightly.