Vacation Bible School Registration

VBS Registration Form

1st Child's Name *
Grade this Fall *
Any allergies? *
YesNo
If you check 'yes' for allergies, please describe
2nd Child's Name
Grade this Fall
Any Allergies?
YesNo
If you check 'yes' for allergies, please describe
3rd Child's Name
Grade this Fall
Any Allergies?
YesNo
If you check 'yes' for allergies, please describe

Parent(s) or Guardian Contact Information

Parent or Guardian's Name *
Email *
Home Phone
Cell Phone *
Home Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home Church

Emergency Contact Information

Emergency Contact Name (parents or guardian will be called first) *
Emergency Contact Phone *
Relationship to Child (or Children) *

Verification

Please enter any two digits with no spaces (Example: 12) *
This box is for spam protection - please leave it blank:

When you submit your registration you will receive a confirmation email. If you do not receive your confirmation, check your spam email folder. If you have any questions, please contact the office at 616-669-9872.