VBS Registration 2023 K4-6th Grade

June 19-23 / 9:00 - 12:00 | To register for VBS 2023 please fill out this form and click submit.

Parent Information

Parent/Guardian First and Last Name

*

Address

*

Email

*

This address will receive a confirmation email

Phone

*

Child Information

Child's First Name

*

Last Name

*

Gender

*

Please select one option.

Male Female

Child must be born on or before September 1, 2018.

Birth Date

*

Grade Last Completed

*

Please select one option.

K4 K5 1st 2nd 3rd 4th 5th 6th Joyful Learner

Child's First Name 2

Last Name

Gender

Please select one option.

Male Female

Must be born on or before September 1, 2018.

Birth Date

Grade Last Completed

Please select one option.

K4 K5 1st 2nd 3rd 4th 5th 6th

Child's First Name 3

Last Name

Birth Date

Grade Last Completed

Please select one option.

K4 K5 1st 2nd 3rd 4th 5th 6th

Medical Information

Medical or other information we need to know.

*

Any known allergies?

*

Please select one option.

Yes No

If yes, list any allergies.

Emergency Contact Info

...other than contact listed above

First and Last Name

*

Phone

*

Dismissal Info

Who is allowed to pick up your child at the end of each day?

*

Please list anyone that is NOT allowed to pick up your child.

*

Other Information

Does your child attend Sunday School?

*

Please select one option.

Yes No

If so, where?

Do we have permission to photograph your child?

*

Please select one option.

Yes No

Do we have permission to use your child's photo for the purpose of promotion?

*

Please select one option.

Yes No

Description

June 19-23 / 9:00 - 12:00

To register for VBS 2023 please fill out this form and click submit.

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