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Vacation Bible School Registration
*
Indicates required field
Parent/Guardian's Name
*
First
Last
Please provide us the Parent/Guardian's name registering the Child.
Parent/Guardian's Phone Number
*
Please provide us a good contact number in case of an emergency
Optional Emergency Contact's Name
*
First
Last
Optional: Please provide us an Emergency Contact's name allowed to pick up the Child in case of an emergency.
Secondary Phone Number
*
Optional: Please provide us a secondary contact number in case of an emergency
First Child's Name
*
First
Last
Please provide us with the Child's first and last name you are registering.
Select just Completed Grade level:
*
Preschool (2-4 year olds)
Kindergarten
First
Second
Third
Fourth
Fifth
12-17 year olds: Sorry, no group, but welcome to assist!
Please select the age group of the First Child you are registering.
Second Child's Name
*
First
Last
Optional: IF you have more than one Child attending, please fill in this information.
Select just Completed Grade level:
*
Preschool (2-4 year olds)
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
12-17: Sorry, no group, but welcome to assist.
Please select the age group of the Second Child you are registering.
Third Child's Name
*
First
Last
Optional: If you have more than two children attending, please fill this information in. If you have more than 3 Children attending, please note their Name and Age Group in the Additional Information box below.
Select just Completed Grade level:
*
Preschool (2-4 year olds)
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
12-17: Sorry, no group, but welcome to assist.
Please select the age group of the Third Child you are registering.
Days attending, First Child:
*
All Week (July 25-29)
Other
If the First Child is able to attend all 5 evenings, please select "All Week". If there are evenings they will not be attending, please select the Other and fill in the days they WILL attend.
If Other, please specify:
*
Days Attending, Second Child:
*
All Week (July 25-29)
Other:
If the Second Child is able to attend all 5 evenings, please select "All Week". If there are evenings they will not be attending, please select the Other and fill in the days they WILL attend.
If Other, please specify:
*
If the Second Child is able to attend all 5 evenings, please select "All Week". If there are evenings they will not be attending, please select the days they WILL attend.
Days Attending, Third Child:
*
All Week (July 25-29)
Other:
If the Third Child is able to attend all 5 evenings, please select "All Week". If there are evenings they will not be attending, please select the Other and fill in the days they WILL attend.
If Other, please specify:
*
If the Third Child is able to attend all 5 evenings, please select "All Week". If there are evenings they will not be attending, please select the days they WILL attend.
Any Additional Children:
*
Please provide us with the Child(ren)'s name and age group(s). If their are unable to attend some evenings, please list the nights they are able to attend.
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Optional: Please provide us with your address
Email
*
Optional: Please provide us with your Email address.
Additional Information: Please list any medical needs, allergies (food, stings, etc.), or any important information we need to know about your Child/Children. If for more than one child, please specify which Child. If there are not any, please reply "none".
*
Please list any medical needs, allergies (food, stings, etc.), or any important information we need to know about your Child/Children. If more than one child, please specify which Child. If there are not any, please reply "none".
How did you find out about our VBS?
*
Friend
Advertisement (saw Signs)
Facebook
Internet Search
Other
Optional: Please select how you heard about our Vacation Bible School. Thank you!
If Other please specify:
*
Submit Registration
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