VBS 2019 Registration

June 9th - 12th 6:00 pm-8:30 pm | Please fill out this form and click submit.

Child's Name

*

Child's Gender

*

Please select all that apply.

Male Female

Child's Age

*

Name of Parent(s)/Guardian

*

Street Address

*

Home Phone

*

Grade Entering in Fall

*

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th Teen Helper

Parent/Caregivers Cell Phone

*

Email

*

Home Church

*

Allergies or other medical conditions:

*

In case of emergency, contact:

*

Phone

*

Relationship to child:

*

Description

June 9th - 12th 6:00 pm-8:30 pm

Please fill out this form and click submit.

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