Vacation Bible School Registration

Family Name *

First Name

Last Name

Parent/Guardian Name(s) *

First Name

Last Name

Primary Phone *

(###)

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

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Child 1 Name *

First Name

Last Name

Child's Gender (1) *

Male

Female

Child 2 Name

First Name

Last Name

Child's Gender (2)

Male

Female

Child 3 Name

First Name

Last Name

Child's Gender (3)

Male

Female

Child 4 Name

First Name

Last Name

Gender (4)

Male

Female

Check here if you DO NOT want photographs or video taken of your child

Pictures and video may be taken during our program. We may use this content for communication and marketing purposes both digital and print. Names will not be posted unless written authorization is given by a parent/guardian, and even then only first names will be used.

I do not want photos or video taken of my child