Vacation Bible School

Registration

(June 23 - 27; 9 am - 12:15pm)

* Child's Name: * Parent/Guardian Name: * Address: Phone Numbers: Home Work Cell * E-mail: Age Information: Birth date (for preschoolers) or last grade completed in school Medical Information: Medical or other information we need to know.  (Please include any food allergies.) Emergency Contact: * Name * Phone Number Name Phone Number * Dismissal Information: Who may pick up your child at the end of each VBS day? Other Information: Do you attend Sunday School? If so where? If you are visiting our church, who are you a guest of? * May we have permission to photograph your child? Yes No * May we have permission to use your child's photograph in church publications for the purpose of promotion? Yes No Due to the high number of computer generated form submissions with spam and other unwanted materials, we have implemented a new form of security to ensure that this material is blocked.  Please note that the code is CASE SENSITIVE. Enter the code shown below: (*) Required