VBS Registration

Join us for Camping VBS July 10-13! Ages 4-12 are welcome. We will meet each night 5:30-8:00pm. A free dinner will be served for the kids starting at 5:30.

Child's Name

First Last

Age(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Dad's/ Guardian's Name(Required)

First Last

Dad/Guardian Cell(Required)

Mom's/Guardian's Name(Required)

First Last

Mom/Guardian Cell(Required)

Emergency Contact(Required)

First Last

Emergency Contact Phone(Required)

Alternate Person Allowed to Pick up Child

First Last

Alternate Pick up Phone Number

Alternate #2 Person Allowed to Pick up Child

First Last

Alternate #2 Pick up Phone Number

Allergies or Health Concerns We Should Know About