VBS 2021 - Final Version

If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)

If you have previously registered with us for a prior event, you can search for your stored information instead of filling out the form below.
Personal Information

*Participant's First Name:
*Participant's Last Name:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
Primary Phone:
(555-555-5555)
Work Phone:
(555-555-5555)
Cell Phone:
(555-555-5555)
Email:
*Birthday:
(MM/DD/YYYY)
*Last Grade Completed:
Are you a member of this church?
Church:
(If not, where do you attend?)
VIP:
(Special Needs Program Includes (Autism; ADHD; Down Syndrome; etc.)
Allergies, Medical, & Special Needs:
(Leave Blank if None)
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
(555-555-5555)
Emergency Contact Name (2):
Emergency Contact Phone (2):
(555-555-5555)
*Authorized Pickup #1:
Authorized Pickup #2:
Southfork:
(Riding the Southfork Bus?)
May we have permission to photograph your child?
May we have permission to use your child's photograph in church publications?
Comments:
Gender:
*Choose the days that your child will attend: