Vaction Bible School (VBS) 2023 - Child Registration

Enter the information below to register your child for our upcoming VBS program. July 24 - July 28, 2023
Please note, ALL Children MUST be potty trained. Staff will not change diapers or pull-ups.
Fee: $25.00 Per Child

Child's Name Child's Name First Last
Gender
Date of Birth Date of Birth / MM / DD YYYY
Child's Age
Grade Completed
Mother's Name: Mother's Name: First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Mother's Day Time Phone Mother's Day Time Phone - ### - ### ####
Email
Father's Name Father's Name First Last
Father's Day Time Phone Father's Day Time Phone - ### - ### ####
Email
Emergency Contact 1 - Person also able to pick up child. Emergency Contact 1 - Person also able to pick up child. First Last
Contact 1 Relationship to Child
Contact 1 Phone Number Contact 1 Phone Number - ### - ### ####
Emergency Contact 2 - Person also able to pick up child. Emergency Contact 2 - Person also able to pick up child. First Last
Contact 2 - Relationship to Child
Contact 2 Phone Number Contact 2 Phone Number - ### - ### ####
Special Needs / Allergies: