VBS Registration
June 21-25th | We are excited to see your child at VBS this summer! Please fill out this form and click submit.
Child's Name
*
Parent/Guardian Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child's Age
*
Child's Birthday
*
Gender
*
Please select all that apply.
Male
Female
Last Grade Completed
*
Please select one option.
PreK 3 yrs-5 yrs (must be potty-trained)
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Medical Info & Allergies
*
Emergency Contact Name
*
Emergency Contact Phone
*
Do You Attend Church Anywhere?
*
Please select all that apply.
yes
no
Name of Church You Attend
*
Do we have permission to photograph your child?
*
Please select all that apply.
yes
no
Submit
Description
June 21-25th
We are excited to see your child at VBS this summer! Please fill out this form and click submit.
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