VBS Registration

Please register your child for VBS using the form below. If you have more than one child attending, please fill out the form for each child individually.

Your Email Address:
Child's First Name:
Child's Last Name:
Child's Date of Birth (MM/DD/YYYY):

Age (As of May 31, 2017):
Grade Completed:
Address:
Home Phone:

Mother's Name:
Mother's Cell Phone:
Father's Name:
Father's Cell Phone:

Emergency Contact Name:
Emergency Contact Phone:

List ALL Food Allergies and other Medical Conditions

List ALL Persons allowed to pick up your child from VBS

What Church do you regularly attend?

By checking this box you give us permission to post your child's image on our facebook page.