VBS REGISTRATION 2024

June 23-27, 6:45-9:00pm | Please fill out this form and click submit.

VBS 2024: “BREAKER ROCK BEACH”
June 23-27, 6:45-9:00 p.m.

Classes will be held for children 3 yrs. old through those entering 6th grade.

Parent 1

Parent's Name

Parent's Email

This address will receive a confirmation email

Parent's Phone

Parent 2

Parent's Name

Parent's Email

Parent's Phone

Additional Information

Address

Church Home

Emergency Contact (other than parents) - Please list name, relationship to child, phone number

Permission to use child(ren)'s picture in slide show, promo materials, etc.

Please select one option.

Yes No

Child #1

Child's Name - First & Last

Gender

Please select one option.

Male Female

Child's Age

Child's Birthdate

Grade in FALL 2024

Please select one option.

Age 3 to Jr. K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Allergies / Medical Conditions

Child #2

Please fill out ALL information for each child registered.

Child's Name - First & Last

Gender

Please select one option.

Male Female

Child's Age

Child's Birthdate

Grade in FALL 2024

Please select one option.

Age 3 to Jr. K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Allergies / Medical Conditions

Child #3

Please fill out ALL information for each child registered.

Child's Name - First & Last

Gender

Please select one option.

Male Female

Child's Age

Child's Birthdate

Grade in FALL 2024

Please select one option.

Age 3 to Jr. K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Allergies / Medical Condition

Child #4

Please fill out ALL information for each child registered.

Child's Name - First & Last

Gender

Please select one option.

Male Female

Child's Age

Child's Birthdate

Grade in FALL 2024

Please select one option.

Age 3 to Jr. K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Allergies / Medical Conditions

Description

June 23-27, 6:45-9:00pm

Please fill out this form and click submit.

VBS REGISTRATION 2024

Description

Please Fix the Following