2019 VBS Registration Form (Please fill out one form per child)

VBS 2019
Monday, July 22 - Thursday, July 25 (5:30 PM-7:30 PM)

Child's Information

Name:

*

Last Grade Completed:

*

Please select one option.

First Second Third Fourth Fifth Sixth

Birth date:

*

Stuff we need to know (Allergies, etc):

Permission to Photograph (For Church Purposes Only):

*

Please select one option.

Yes No

Who May Pick Up Child:

*

This Child may walk home by themselves?

*

Please select all that apply.

Yes No

Parents Information

Parent/Guardian Name:

*

Address

*

Email

*

This address will receive a confirmation email

Primary Phone:

*

Secondary Phone:

Description

VBS 2019
Monday, July 22 - Thursday, July 25 (5:30 PM-7:30 PM)

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