2019 VBS Registration

Child's Full Name:

Parent/Guardian Full Name:

Address

Child's Birthday (MM/DD/YYYY)

Home Phone:

Cell Phone:

Emergency Contact Name:

Emergency Contact Phone:

Email:

This address will receive a confirmation email

Grade Completed by June:

Medical Information:

Any medical information we need to know. (please include food allergies)

Who invited you to VBS this year:

Description

June 24-28 2019, 6:00pm-8:30pm

Please fill out this form and click submit.