Registration Please complete this form to register your child for our upcoming VBS. All fields marked with an *asterisk are required. Children will not be released without a valid photo id from the parent or guardian. Child’s Name* First Last Gender* MaleFemale Birthdate* Date Format: MM slash DD slash YYYY Grade Completed* Kindergarten First Second Third Fourth Fifth Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent or Guardian Name* First Last Email* Enter Email Confirm Email Cell Phone* Emergency Contact Name* First Last Relationship to Child* 0 of 15 max characters Emergency Contact Phone Number* Name of Home Church* 0 of 40 max characters Does Your Child Have Any Allergies?* NoYes Please List Medical Concerns* NoYes Please List Does this child have siblings attending VBS also NoYes Please List Who is Authorized to Pick Up this Child* First Last Phone Please List Who is Authorized to Pick Up this Child First Last Phone Please List Who is Authorized to Pick Up this Child First Last Phone Phone This field is for validation purposes and should be left unchanged.
