Vacation Bible School Learner Registration (Summer 2024)

June 16-20, 2024, 6:00 - 8:30 PM | Please fill out this form and click submit.

VBS is for all children entering Grades K5-7th in Fall 2024

Registration Input Data

Today's Date: (mm/dd/yyyy)

Family Name: (i.e., "The Smith Family")

Child's Information

Student's Name:

Birthdate: (mm/dd/yyyy)

Student's Cell: (if any)

For security purposes, please upload a new (or recent) head-shot photo of your child:

Upload (8MB)

Gender:

Please select one option.

Female Male

Grade completion during 2023-24 school year:

Please select one option.

Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Rising K-5 2022/23 Kindergarten

School Name:

T-Shirt Size:

Please select one option.

Y-Small Y-Medium Y-Large Y-XL A-Small A-Medium A-Large A-XL A-2X A-3X

Address

Parent's Information

Parent/Guardian Name (1): (first/last)

Preferred Phone:

Alternate Phone:

Email:

This address will receive a confirmation email

Parent/Guardian Name (2): (first/last)

Preferred Phone:

Alternate Phone:

Email:

This address will receive a confirmation email

Emergency Contact Information

Please provide one LOCAL contact (other than the child's parent) that we can contact in an emergency if we can't reach a parent first.

Emergency Contact Name: (first/last)

Emergency Contact Phone:

Medical Information

List any allergies, medical needs, etc. If none, please type N/A

Authorized Pick-up Persons

Please include first/last names (including parent[s]) of any/all people who are authorized to pick-up your child from VBS. NOTE: Authorized pick-up person[s] are required to have your child's SECURITY tag with them at pick-up time. We WILL NOT release ANY child to any person who DOES NOT possess the child's SECURITY tag.

List ANY/ALL authorized pick-up people by name: (first/last)

Closing Data

Name of person completing this form: (first/last)

Comments:

Description

June 16-20, 2024, 6:00 - 8:30 PM

Please fill out this form and click submit.

VBS is for all children entering Grades K5-7th in Fall 2024

Vacation Bible School Learner Registration (Summer 2024)

Description

Please Fix the Following