VBS Registration Form

June 8-12. Dinner begins at 5:30. | Please fill out this form and click submit.

Child Information

Name

*

Birthdate

*

Last Grade Completed

*

T-shirt size ($10 donation requested but not required)

*

Please select one option.

YS YM YL YXL AS AM AL AXL I would not like to order a shirt for my child.

Parent/Guardian Information

Name

*

Relation to Child

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Emergency Contact Information (at least two)

*

Medical Information (Please include any food allergies)

*

Dismissal Information (Who may pick up your child each day)

*

May we have permission to photograph your child?

*

Please select all that apply.

Yes No

Do you have a home church?

*

Please select all that apply.

Yes No

Description

June 8-12. Dinner begins at 5:30.

Please fill out this form and click submit.

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