VBS Registration

VBS is for kids that have completed grades K-6

Child First Name:
Child Last Name:
Birth Month:
Birth Day:
Birth Year:
Grade Completed:
Age:
Parent First Name:
Parent Last Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
List All People Who Are Allowed to Pick Up Your Child:
Emergency Contact:
Emergency Phone:
Special Needs/Allergies:
Home Church (if any):
I authorize my child's photo to be taken and used for our website use.
How did you hear about this event?
We understand your child would like to be in a group with all his/her friends however in an attempt to help all children have a great experience, your child will be in a group with mixed ages. If your child would like to be placed in a group with ONE friend, please provide that in the space provided. We will do our best to accommodate, however we cannot have one group of all friends. Our desire is that all the children feel included, welcomed, loved and hopefully they will leave VBS making new friends! If possible please place my child in a group with