Registration Form

You may use the form below to register for our 2014 Vacation Bible School.  We will print out the form, but you will still need to sign it when you drop your child or youth off for Vacation Bible School.  If you have any questions, please contact us.

Child's Name (required)

Parent/Guardian Name (required)

Address (required)

E-mail Address (required)

Home Phone Number (required)

Cell Phone Number

Work Phone Number

Child's Age Information (required)

Child's Date of Birth (required)

Child's last school grade completed (required)

Home Church

Child's Allergies/Medical Information

Emergency Contact Person One's Name (required)

Emergency Contact Person One's Phone Number (required)

Emergency Contact Person Two's Name

Emergency Contact Person Two's Phone Number

Dismissal Information: Name(s) of person(s) who may pick up this child from VBS (required)

During Vacation Bible School, we will be taking pictures. We would like to use these pictures for promotional and communicational purposes. We will not identify your child or provide any specific information about your child. Will you grant us permission to use pictures of your child?(required)

We will submit photographs to the Press Enterprise. Could we use your child's name and his or her picture to submit to the paper?< br/>

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