The first night of VBS is always a little hectic at the door with everyone trying to get registered. You can help us out by pre-registering! This will help keep the line down at the entrance and get you in and out more quickly the first night.

Register today by filling in the blanks below.

Thank you for your help!

One registration per child. Fields marked with an asterisk are required.

Child's Name

First Name

Last Name

Child's Gender

Male

Female

Child's Age

Child's Date of Birth

MM

DD

YYYY

Last Grade of School Completed

Preschool

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Name of Parent(s) / Legal Guardian(s)

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Telephone

Parent/Guardian Cell Phone

Email Address

Home Church

Emergency Information

Allergies or Other Medical Conditions (specify NONE if not applicable)

Emergency Contact (after Parent/Guardian)

Emergency Contact Relationship to Child

Emergency Contact Phone Number

Any other information we should know?