REGISTRATION FORM

VBS is Tuesday, July 8, through Friday, July 11. Tuesday-Thursday, the time is 9 AM-Noon. Friday, it is 9 AM- 1 PM.
The BBQ Block Party is Friday evening from 5:50-8:00 PM. The whole family is invited!

Child #1

First Name

Last Name

Date of Birth

YYYY

Grade Just Completed

T-shirt Size

Child #2

First Name

Last Name

Date of Birth

YYYY

Grade Just Completed

T-shirt Size

Child #3

First Name

Last Name

Date of Birth

YYYY

Grade Just Completed

T-shirt Size

Child #4

First Name

Last Name

Date of Birth

YYYY

Grade Just Completed

T-shirt Size

Parent/Gaurdian

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gaurdian's Phone

(###)

###

####

Gaurdian's Email

Medical Information

Medical or other information we need to know. (Please include any food allergies.)

Emergency Contacts

Names & Phone Numbers (other than listed above)

Dismissal Information

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

May we have permission to photograph your child?

Yes

LOCATION

SERVICE TIMES

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FOR THE GLORY OF CHRIST AND THE LIFE OF THE WORLD.