VBS: Student Registration Form

Please fill out this form and click submit.
VBS will run August 19th-23rd from 9:00am-12:00pm.

Child Information

Child's Name

*

Child's Age

*

Please select all that apply.

3 4 5 6 7 8 9 10 11

Child's Grade (Fall 2024)

*

Please select all that apply.

Pre-K (3's & 4's) Kindergarten 1st 2nd 3rd 4th 5th

Do your child have any allergies?

*

Please select one option.

Yes No

If yes, please explain

Does your child have any medical issues you'd like us to be aware of:

*

Please select one option.

Yes No

If yes, please explain

*

Parent Information

Parent/Guardian Name (s)

*

Phone

*

Work Phone

Email

*

This address will receive a confirmation email

Emergency Information

Emergency Contact 1

*

Phone

*

Emergency Contact 2

*

Phone

*

Doctor

*

Phone

*

Dismissal

Who may pick up your child at the end of each VBS day?

Name

*

Relationship

*

Name

*

Relationship

*

Photo Permission

May we use your child's photo on various social media platforms? (Facebook, Instagram, Church Website, etc.)

*

Please select one option.

Yes No

Description

Please fill out this form and click submit.
VBS will run August 19th-23rd from 9:00am-12:00pm.

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