VBS 2021
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
WE CAN ONLY ACCEPT CHILDREN WHO COMPLETED KINDERGARTEN THRU 6TH GRADE. I give my permission for my child to take part in all VBS activities and absolve the church from liability to me or my child because of any injury at VBS during any activity. If you agree to the above, and give permission for your child to participate in VBS, please complete the following form.
*Participant's First Name:
*Participant's Last Name:
*Preferred Name for Name Tag:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
*Primary Phone:
(555-555-5555)
*Cell Phone:
(555-555-5555)
*Email:
*Birthday:
(MM/DD/YYYY)
*Last Grade Completed:
Allergies, Medical, & Special Needs:
(Leave Blank if None)
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
(555-555-5555)
*Authorized Pickup #1:
Authorized Pickup #2:
Are you a member of this church?
Guest of:
Do you attend Church?
If so, where?
May we have permission to photograph your child?
May we have permission to use your child's photograph in church publications?
Comments:
Gender:
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