VBS 2024 REGISTRATION

July 14-18, 2024 from 6:00-8:30 p.m. | Please complete this form to reserve your child's space in our 2024 VBS.

Child's Name

*

Gender

*

Please select one option.

Male Female

Birthdate

*

Grade Completed

*

Address

*

Home Phone

Cell Phone

*

Parents/Guardian

*

Email

*

This address will receive a confirmation email

Emergency Contact

*

Relationship to Child

*

Phone

*

Who can pick up your child?

*

Name of home church

Food allergies?

*

Please select one option.

Yes No

List food allergies

Medical concerns

*

Please select one option.

Yes No

Explain any medical concerns

May we use your child's photo in promotional materials?

*

Please select one option.

Yes No

Breaker Rock Beach Theme T-Shirt

OPTIONAL: If you would like to order a VBS t-shirt for your child, they are available at $12 each with money due to Kortney by June 21. Please select the size needed below.

T-Shirt Size

Please select all that apply.

Youth X Small Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Description

July 14-18, 2024 from 6:00-8:30 p.m.

Please complete this form to reserve your child's space in our 2024 VBS.

Please Fix the Following

Close