VBS Registration Form

July 29 - July 31 from 6 - 7:45pm | Please fill out this form and click submit.

Child's Name

*

Grade Completed

*

Birthday

*

Age

*

Wuold you be interested in buying your child a VBS T-Shirt? Shirts will be on sale during VBS. The price is $10.

*

Please select one option.

Yes No

T-Shirt Size

Please select one option.

Youth Extra Small Youth Small Youth Medium Youth Large Youth Extra Large Adult Extra Small Adult Small Adult Medium Adult Large Adult Extra Large

Home Address

*

Parents' Names

*

Phone

*

Email

*

This address will receive a confirmation email

Emergency Contact Person

*

Relationship to Child

*

Phone

*

Does your child have food allergies? If so, list them. If not, type N/A.

*

List any medical concerns that you may have. If none, type N/A.

*

Family Doctor

*

Doctor's Phone

*

Siblings attending VBS (names and ages)

*

Number Attending

*

Can your child be in VBS photos and/or videos?

*

Please select one option.

Yes No

Parent's Signature

*

Description

July 29 - July 31 from 6 - 7:45pm

Please fill out this form and click submit.

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