VBS2024

July 22-25 6pm-8:30pm

2024 VBS Registration Form (Please complete 1 form per child)

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Name

First

Last

Childs Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Boy or Girl

Boy
Girl

Child's Address (If different than above)

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth ( MM/DD/YYYY)

Last Grade Completed

Medical Information (Please include food allergies)

Emergency Contact 1 (Name, Relationship, Phone Number)

Authorize to Pick Up (We will require ID)

Yes

Emergency Contact 2 (Name, Relationship, Phone Number)

Authorize to Pick Up (We will require ID)

Yes

Dismissal Information - Who may pick up your child? (Enter name of anyone authorized)

Does your child attend Church? If so, where

Do we have permission to photograph your child (Used only for VBS promotional purposes)

Yes
No