VBS Registration Form

Child's Name(required)

Invited By

Child's Age(required)

Grade Entering In Fall(required)

Parent/Guardian Name(required)

Address(required)

City(required)

State(required)

Phone Number(required)

Email Address(required)

Home Church

Person Registering Child(required)

Relationship to Child(required)

Emergency Contact Name(required)

Emergency Contact Phone(required)

Any Other Person Who May Take the Child Home

Allergies

Additional Information

I understand that photos will be taken and may be put on the church website and/or Facebook page.(required)

Signature(required)