Child First Name (required)

Child Last Name (required)

Child's Gender (required)

Child's Age (required)

Child Birthday (required)

School Grade Completed (required)
JKSK123456789101112

Allergies or Other Known Health Conditions (required)

Parent or Caregiver First Name (required)

Parent or Caregiver Last Name (required)

Address (required)

Phone Number (required)

Your Email (required)

Emergency Contact First and Last Name (required)

Relationship to child (required)

Primary Emergency Number (required)

Do you authorize for us to take pictures or videos of your child(ren) to be used for VBS related purposes such as the Closing Ceremony slideshow? (required)
—Please choose an option—YesNoI need more information

How did you hear about VBS? (optional)
—Please choose an option—Family and FriendsChurch WebsiteChurch BulletinGoogle SearchI'm a church memberOther

If you have any questions, please write your question in the field below and we will get back to you. (optional)