Vacation Bible School Online Registration Form

*Please fill out a form for each child.

Please enter the student's full name. *
First Name
Middle
Last Name
Child's Preferred Name
Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Parent/Guardian Name *
First Name
Middle
Last Name
Parent/Guardian Cell Phone*
Parent/Guardian Home Number*
Parent/Guardian Work Number
Parent/Guardian Email Address*
Parent/Guardian Name (2)
First Name
Middle
Last Name
Parent/Guardian Cell Phone (2)
Parent/Guardian Email Address (2)
Birthdate (mm/dd/yy) Must be 4 by December 31, 2017.*
PRESCHOOL - Please check one of the following classrooms for your child's birthdate:
KINDERGARTEN - If your child has just completed kindergarten, you have a choice to place them with Preschool or Elementary classes. If you choose elementary, they will do activities the older kids do but will not be in the same class as 1st-4th grade
GRADE SCHOOL (1ST-6TH GRADE) - Please choose the last grade completed in school.
Please list medical or other information we need to know, including food allergies.*
Emergency Contact #1 (other than listed above)*
Contact Number:*
Emergency Contact #2 (other than listed above)
Contact Number:
Who (other than those listed) may pick up your child at the end of each day?*
I/We currently attend a church:*
If yes, where?
May we have permission to photograph your child and use it for promotional purposes?*
By putting your name here you are agreeing to the permissions listed above and stating that everything is correct.*
Today's Date*
*