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VBS 2022 - JULY 26, 27, 28 (Tuesday, Wednesday, Thursday)

6:15-8:15 PM VBS Activities (including a built in snack time during the rotation) All children ages 3 (must by potty trained) through 5th grade welcome

Child's Name(Required)

First Last

Parent/Family/Guardian Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Date of Birth

Age

Last Grade Completed in School(Required)

Home Church (if any)

Friends of your Child at this Church

Special Needs/Allergies/Medical Information/Other:(Required)

Emergency Contact Name & Phone(Required)

Emergency Contact Name & Phone

Name(s) of Person(s) who may Pick up this Child from VBS

Signature (type your name for signature) & Date Signed(Required)

VBS 2022 - JULY 26, 27, 28 (Tuesday, Wednesday, Thursday)

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