Vacation Bible School REGISTRATION FORM

Your Name (required)

Your Email (required)

Subject

Your Message

Child's Name (required)

Gender (required)
MaleFemale

Birth Date (required)

Last Grade Completed in School (required)

Parent/Guardian Name (required)

Address (required)

City

State

Zip Code

HOME Phone(required)

CELL Phone (required)

WORK Phone

EMAIL

Medical Information: Medical or other information we need to know. Please include food allergies.

EMERGENCY CONTACTS (required)

Name

Phone

Name

Phone

Do you attend Church? If so, Where?
yesno

May we have permission to photograph your child(required)
yesno

May we have permission to use your child's photograph in church publications for the purpose of promotion(required)
yesno

Please click on the "Send" button below to complete the online registration process. Thank You!

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