VBS Registration

This form is provided to register for Vacation Bible School. For a printable version of this document CLICK HERE.

* Required fields
Student Name*
Male Female
Grade Completed 3 years old 4 years old Kindergarten First Second Third Fourth Fifth
Address*
City*
State*
ZIP code*
Home Phone*
Birthdate MM/DD/YYYY*
Age*
Primary Contact's E-mail Address*
Mother's Name
Mother's Cell Phone
Father's Name
Father's Cell Phone
Emergency Contact Name
Emergency Contact Phone
T-Shirt Size (cost $5 each) Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X Large
Allergies or other conditions which may limit activity