VBS Registration

ONLINE REGISTRATIONS WILL NOT BE ACCEPTED AFTER THURSDAY, JULY 7th!
PLEASE COME IN AND FILL OUT A FORM FOR YOUR CHILD ON THE FIRST NIGHT OF VBS!

* Indicates required field

Child's Name: *

First

Last

Age and Last Grade Completed *

Parent/Guardian Name *

Email *

Address *

Home Phone *

City, Zip *

Cell Phone *

Emergency Contact Name and Phone (other than parent): *

Please list any diseases, physical, or mental conditions. (Asthma, Diabetes, Autism, Etc.) *

List allergies (food, medication, insects, etc.) *

Medical Concerns or Other Information: *

Van Pick Up Needed? *

Submit