VBS Registration

Please fill out this form if you have a child participating in VBS.

"Train up a child in the way he should go, Even when he is old
he will not depart from it." Proverbs 22:6 NASB95

Child Information
Child's Name:
  
Date of Birth:
  
Last Grade Completed:
  
Allergies/Medical Information/Other:
Parent/Guardian Information
Name:
  
Address:
  
City:
  
State:
  
Zip Code:
  
Email:
   
Home Phone:
  
Cell Phone:
  
Work Phone:
Home Church:
Emergency Contact Information
Name 1:
  
Phone 1:
  
Name 2:
Phone 2:
 
 
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