VBS 2023 Registration Form

"*" indicates required fields

Child’s Name*

Parent/Guardian Name*

Address*

Mailing Address*

Same as above

Contact Information

Phone Numbers

Best Phone*

Alt Phone 1

Alt Phone 2

Age Information

Birth Date*

Last Grade Completed in School*

Medical Information

Medical or other information we need to know. (Please include any food allergies.)

Emergency Contacts

Please include at least two emergency contacts, not including the parent/guardian listed above.

Emergency Contact #1*

Emergency Contact #1*

Emergency Contact #1 Phone*

Emergency Contact #2*

Emergency Contact #2*

Emergency Contact #2 Phone*

Emergency Contact #3

Emergency Contact #3

Emergency Contact #3 Phone

Dismissal Information*

Please list the names of those with permission to pick up your child at the end of VBS each evening.

Other Information

Does your child attend church?*

Yes

Where does your child attend church?*

Is your child a guest of another child attending VBS?*

Yes

Please enter the name of the other child:*

May we have permission to photograph your child?*

Yes

May we have permission to use your child’s photograph for the purpose of promotion?*

Yes

Name

This field is for validation purposes and should be left unchanged.

Contact Information

Age Information

Emergency Contacts

Other Information

Visitors

News & Events

Ministries

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