Please complete the following form to register you child for Vacation Bible School


Parent/Guardian's Name:  (Required Field)

Email Address:

Child's Name:  (Required Field)
Address:  (Required Field)
City:  (Required Field)
State:  (Required Field)
Zip Code:  (Required Field)
Home Phone:  (Required Field)
Cell Phone:

Age of Child.  (Must be 5 yrs. old):  (Required Field)


Child's Birthday: (Required Field)


Grade your child has completed:  
    Pre-K
    Kindergarten
    1st
    2nd
    3rd
     4th
    5th
    6th
Emergency Contact Name:  (Required Field)
Emergency Contact Phone:  (Required Field)
Who will pick up your child at 12:30 dismissal time?  (Required Field)
 Allergies or Medical Alerts:

Do we have permission to show your child's photo during our Slide Shows? (Required Field)  YES 
  NO  
May we invite you to future events?
 YES 
  NO