Child's First Name (required)

Child's Last Name (required)

Child's Age (required)

Child's DOB mm/dd/yyyy (required)

Child's Grade - refers to grade completed during the 2018/2019 school year (required)

Child's Shirt Size (required)

Parent's Name - first and last (required)

Address (required)

Your Email (required)

Phone Number (required)

Emergency Contact (required)

Emergency Contact Phone (required)

Please list all name of people (including parents) who will be picking up/dropping off child (required)

Allergies (if any)

Any additional information you would like to provide

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Vacation Bible School 2019
JULY 21-25 * 6pm – 8:15pm
Cost $10/child or $20/family
– includes t-shirt, CD, and more!
Age 4yrs to 5th Grade 
some scholarships available — contact Pastor Jeb for info
*In order to participate in VBS 2019, children MUST
have turned 4yrs old BY the last day of VBS – July 25, 2019
 GRADE LEVELS REFER TO GRADE COMPLETED DURING THE 2018/2019 SCHOOL YEAR
 
Please make sure to pay the registration fee in order to be completely registered for VBS.  Thank you!!