Vacation Bible School Registration

June 9 - 13, 2025; @6:00pm to 8:30 PM

Registration is from 5:30 to 6:00 PM
For Children 4 yrs old through completion of 6th grade

Childs Name

Date of Birth

Grade Completed

Food Allergies

Any other information you would like for us to know about your child(ren); ADD, ADHD, etc..

Sibling; Name, DOB, Grade Completed, Food Allergies

Parent/Guardian Name

Mailing Address

Home Phone

(###)

###

####

Cell or Work Phone

(###)

###

####

Name of authorized persons to pickup your children

Do you have a home church?

What is your home church?

Is there a friend your child would like to be with?

Media Release

Permission to photograph your child(ren) for possible posting to social media

Yes