VBS Registration

Please fill out one child at a time.
children must be at least 3 years of age & Fully Potty Trained
at the time of VBS.

* Indicates required field

Child's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

Grade entering this school year *

Phone Number *

Email *

Emergency Contact *

First

Last

Phone Number *

Relationship to Child *

Known Allergies *

Name of Home Church *

Media and Photo Release *

Submit