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:
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*
*