Child Being Registered (required)

Name of Parents (required)

Gender (required)

Childs Age (required)

Last Grade Completed (required)

Street Address (required)

City (required)

State(required)

Zip(required)

Home Phone(required)

Parent or Caregiver Cell Phone(required)

Your Email (required)

Home Church (required)

In case of Emergency Name 1 (required)

In case of Emergency Phone 1(required)

Emergency Contact 1 relationship to child(required)

In case of Emergency Name 2 (required)

In case of Emergency Phone 2(required)

Emergency Contact 2 relationship to child(required)

Allergies and Other Medical Conditions(required)

Who may pick up your child at the end of VBS each night?(required)

If your child is visiting, who is he/she a guest of?(required)

May we have permission to take and use photograph of your child?(required)