2017 VBS Sign-up
Child's Name
*
First Name
Last Name
Child's Age
*
Date of Birth
*
Grade Completed
*
Name of Parent/Guardian #1
*
First Name
Last Name
Name of Parent/Guardian #2
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Parent/Guardian E-mail
*
In case of emergency, contact
*
First Name
Last Name
Emergency Phone Number
*
-
Area Code
Phone Number
Relationship to child
Allergies or other medical conditions
*
Home church
Register
Should be Empty: