Child's Name (required)

Parent/Guardian Name (required)

Email address

Address (required)

Phone Number (required)

Child's Date of Birth (required)

Last Grade Completed (required)

Emergency Contact(s) and Phone Number (required)

Medical information (please include food allergies) (required)

Do you attend church?
 Yes No

If so, where?

May we photograph your child during VBS? (required)

 Yes No

          
VBS Registration