Register for VBS

Name of Home Church:

Address *

Please list all Medical Concerns.

Grade Completed *

Child’s Name: *

Parent/Guardian’s Name: *

Emergency Contact: *

Food Allergies? *

Yes

No

Gender *

Who can pick up your child? *

Register me for Mystery Island!

Email

Emergency Contact Phone *

Medical Concerns? *

Yes

No

Please List all Food Allergies.

Relationship to Child: *

Birthdate *

Cell/Home Phone (from 6:00 - 8:30 pm) *