• Child's name*
  • Last grade completed*
  • Parent/Guardian name*
  • Parent/Guardian phone #*
  • Address*
  • Email Address*
  • Emergency contact*
  • Emergency contact phone #*
  • Relationship to child*
  • Food allergies?*
  • If yes, please tell us what foods your child is allergic to.
  • Medical conditions?*
  • If yes, please tell us what medical conditions we should be aware of.
  • Family members also attending VBS: (names & ages)
  • Do you have a home church?*
  • T-shirt size*
  • Is there any other information we should be aware of?
  • VBS leaders may photograph/film the minor listed above in any manner or form for any lawful purpose associated with this VBS program.

  • I agree*
  • Security Code*

     

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