VBS Dates/Times
June 11-June 14
Tues-Thurs 8:30am-noon
Friday 8:30am-6:30pm
Friday at 6:30pm is Our Parents Night

Please fill out all fields and submit this form for each child attending VBS.

In order to attend – your child must be 4 years old by Sept. 1, 2018.


* Child's First and Last Name:
* Parent/Guardian's First and Last Name:
Physical Address:
Mailing Address (if different from above):

Parent/Guardian Contact Information

* Cell Phone Number:
Work Phone Number:
Email Address:

Child's Age Information

Birth Date (mm/dd/yyyy):
What grade did your child just finish?

Medical Information

Medical or other information we need to know. (Please include any food allergies.)

Emergency Contacts (Other than listed above.)


Phone Number


Phone Number

Dismissal Information

Who may pick up your child at the end of each VBS day?

Other Information

Does your child attend another church? If yes, where?
If your child is visiting our church, who is he a guest of?
May we have permission to photograph your child? YesNo
May we have permission to use your child's photograph for the purpose of promotion? YesNo


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