VBS Registration Form

Event date: July 17-21 6:15pm-8:30pm
and Sunday July 23 at 10am

>> Go here for our VBS Ministry Partner Registration Form

Age 3 years through completed sixth grade.

Note: Please use TAB BUTTON. Return button will submit.

Parent Name(s):

Phone:

Cell phone:

Email:

Address 1:

Address 2:

City:

State:

Zip:

Emergency Contact:
Emergency Phone:

Church home (None/ICN/Other):

Referred by:


Note: Parents must remain on site if children are not potty trained.
Preschoolers who need to be with friends, please state so in comments.

CHILD 1:  

Child's Name:

Birthday
(MM/DD/YYYY):

Grade completed
as of June 2017:

Medical Concerns and/or allergies:

Password (required):

CHILD 2:  

Child's Name:

Birthday
(MM/DD/YYYY):

Grade completed
as of June 2017:

Medical Concerns and/or allergies:

Password (required):

CHILD 3:  

Child's Name:

Birthday
(MM/DD/YYYY):

Grade completed
as of June 2017:

Medical Concerns and/or allergies:

Password (required):

CHILD 4:  

Child's Name:

Birthday
(MM/DD/YYYY):

Grade completed
as of June 2017:

Medical Concerns and/or allergies:

Password (required):


Comments: