| T-shirt registration deadline is Wednesday, May 29, 2024. Classes will be filled on a first-come/first-served basis. PK/K will be capped at 90 total students. Grades 1st - 6th will have a capacity of 55 students per grade. Should you register and then not be able to attend, please let us know of this change by contacting our VBS Director, Monica Williams. monica.williams@villagebible.org |
| *Participant's First Name: |
__________________________________ |
| *Participant's Last Name: |
__________________________________ |
| *Parent/Guardian Name: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| *Grade in fall of 2024: |
__________________________________ |
| *Birthday: |
__________________________________ |
| *Gender: |
Male Female (circle one) |
| *T-Shirt Size: |
__________________________________ |
| *Church attendance: |
YES - I regularly attend Village Bible Church - Sugar Grove Campus.
NO - I do not regularly attend Village Bible Church - Sugar Grove Campus. (circle one) |
| Church Name: |
__________________________________ |
| Allergies, Medical & Special Needs: |
__________________________________ |
| *Health Insurance Company: |
__________________________________ |
| *Insurance Policy Number: |
__________________________________ |
| *Physician's Name: |
__________________________________ |
| *Physician's Phone Number: |
(______)______-________ |
| *Medical authorization in case of an emergency: |
Y N (circle one) |
| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| *Authorized Pickup #1: |
__________________________________ |
| Authorized Pickup #2: |
__________________________________ |
| Comments: |
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