Event Registration

Register for our event by filling out the information below:

Child's Name

Child's Grade (that they recently completed)

Child's Date of Birth

Parent Information

Parent Name(s)

Email Address

Home Phone Number

Alternate Phone Number

What is the best way to reach you?

Phone

Please enter your full address:

Street Address

City

State

Zip Code

Emergency Contact Information

Emergency Contact Name

Relationship to Child

Home Phone Number

Alternative Phone Number

Does the child have allergies?

YES

If so, please list them below:

Does the child have any medical concerns?

YES

If so, please explain below

Do you have a home church?

YES

If yes, where do you attend?

Who may pick up your child?

Please be aware that you will be asked to sign a medical release form upon dropping off your child on the forst day of VBS. Please prepare accordingly.

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