Vacation Bible School Registration Form


Ages 5 through 12

Select which Vacation Bible School to attend:

Child's First Name: (required)

Child's Last Name: (required)

Parent/Guardian's First Name:

Parent/Guardian's Last Name:

Street Address: (required)

City: (required)

State: (required)

Zip Code: (required)

Email: (required)

Telephone (home): (required)

Telephone (cell):

Telephone (work):

Birth date(*): (required)

Grade (as of Fall 2016): (required)

Age: (required)

Which church site does your child attend?

Does your child have any allergies or any other important medical information that we need to know about? (required)

If there are any allergies or medical issues, please list them:

In case of emergency, please contact: (required)

Emergency contact phone number: (required)

In case of emergency, please contact(2):

Emergency contact phone number(2):

Name(s) of person(s) who may pick up this child from VBS: (required)

Non-tagged photos of my child may be used for informational or social media purposes.? (required)

My child has my permission to participate in VBS at: (required)

Volunteers:

I am available to help with VBS. I understand that I must complete “Safe Environment” training and submit to a background check: (required)

Additional Comments?

(*) Depending on your browser, the date can be accepted in many ways. Below are a few examples.

Microsoft Internet Explorer: (YYYY-MM-DD)
2016-01-05

Microsoft Edge with Windows 10: (has the ability to click and select a date, but uses MM-DD-YYYY)

Google Chrome: (has the ability to click and select a date, but uses MM-DD-YYYY)

If problems persist, please email the webmaster (email at the bottom of this page) with the browser you are using.