VBS REGISTRATION

VBS 2021 REGISTRATION

* Indicates required field

Name *

First

Last

Phone Number *

Address *

Birth Date *

Last Grade Completed *

Any Medical Information We Should Know About? (Example: food allergies) *

Emergency Contacts & Phone Numbers (other than listed above) *

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

Does your child attend church? If so where? *

May we have permission to photograph your child? *

Yes No

May we have permission to use your child's photograh for the purpose of promotion? *

Yes No

Submit

For questions please call our church office at 618-756-2252.