VBS Registration

Sunday, June 24-Thursday, June 28 from 6:00-8:00pm

 

First Name*
Last Name*
Age*
2018-2019 School Grade *
Address*
City*
State*
Zip Code*
Parents Names*
Phone Number*
My child would like to be in a group with
Home Church
Emergency Contact Name*
Emergency Phone Number*
Hospital of Choice (In case of emergency)*
Allergies
Special Needs/Other Concerns
Permission to Pick Up (other than parents)