Welcome to Vacation Bible School Registration!
June 18-22, 2018
Child's Name (First/Last) *

Parent/Guardian Name (First/Last)

Home Address

Home Phone

Work Phone

Cell Phone

Email Address

(Date of Birth for Preschoolers ONLY)
Preschoolers Must Be Potty Trained

Medical or Other Information We Need to Know (Please include any food allergies)

Emergency Contacts (while your child is with us at VBS)


Phone Number


Phone Number

Who may pick-up your child at the end of each VBS day?

Do you attend Sunday School (Yes/No)? If so where?

If you are visiting our church, how did you hear about VBS?

May we have permission to photograph your child?

May we have permission to use your child's photograph in church publications for the purpose of promotion?

Thank you for registering for Vacation Bible School! Looking forward to seeing you June 18th!
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