VBS Registration

This form will be automatically emailed to the church. You will be contacted via phone prior to VBS. Thank you for your registration, see you in June!
Childs Name*:
Grade Completed*:
Birthday*:
Age*:
Parents Names*:
Home Address*:
Home Phone*:
Alternate Phone*:
Emergency Contact *:
Food Allergies?*:YN
List Allergies :
Medical Concerns*:YN
Explain Medical Concerns::
Family Doctor*:
Doctor Phone*:
Siblings or Friends attending VBS (names and ages):
Which church are you a member of?:
People who may pick up your child?*:
Transportation needed?:YN
Emergency Contact Phone Number:
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