Vacation Bible School 2019

Use this form to register for Vacation Bible School 2019, which will be held July 15 – 19, from 9:00 AM – 12:00 PM each day, at the church. All kids age 3 through grade 6 (as of September) are welcome!

Name
First Last
Child's Birthdate
Date Format: MM slash DD slash YYYY
Age/Grade In September
School
Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian #1 Name*
First Last
Parent/Guardian #2 Name
First Last
Parent/Guardian #1 Phone*
Parent/Guardian #2 Phone
Email Parent/Guardian #1*
Your registration confirmation will be emailed to this address.
Additional Emergency Contact
First Last
Relationship to Child
Pick up Persons
Names of additional persons authorized to pick up your child. For safety, only authorized persons may pick up attending children.
Medical Conditions, Allergies, etc.
Phone
This field is for validation purposes and should be left unchanged.

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