Please use the following form to register your child (children) for our 2019 “In The Wild” VBS! Please note, even if pre-registered, you must personally drop off and pick up your child (children) each night of VBS.
 
On Thursday, we are asking all parents/care-givers to remain with their children for our family service and the following fellowship time in our gym.
 
 
 
 
 
 
 

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)