Register

Please remember than all children will have outdoor activities; therefore, PLEASE have your child(ren) wear CLOSED-TOE shoes.
All preschool children MUST be potty trained. Thank you!

* Indicates required field

Child's Name *

First

Last

Child's Grade in the fall *

Child's Age *

Parent's Name(s) *

First

Last

Street Address *

City *

Home Phone Number *

Cell Phone Number *

Allergies or Medical Conditions *

Emergency Contact Name and Number *

I am a member of a church *

YES NO

If you have multiple children attending VBS, please check this box and put additional children's names and grades in the bo x below *

I have multiple children attending VBS

Please list the name(s) and grade(s) of additional children. Shirt sizes, if wanted, should be listed here too. Any medical conditions or allergies should also be listed. *

By typing my name below, I agree that the VBS workers may photograph or film the minor registered and designated on this form for any lawful purpose associated with this VBS program. *

​Please remember than all children will have outdoor activities; therefore, PLEASE have your child(ren) wear CLOSED-TOE shoes.All preschool children MUST be potty trained. Thank you!

Please remember than all children will have outdoor activities; therefore, PLEASE have your child(ren) wear CLOSED-TOE shoes.
All preschool children MUST be potty trained. Thank you!