2024 VBS Registration- Camp Firelight- June 3-6, 6:00-8:00pm
Please fill out this form and click submit.
Parent Name:
*
Email
*
This address will receive a confirmation email
Phone (xxx-xxx-xxxx) Please provide number that we could reach you at during VBS
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child #1 Name (First and Last)
*
Child #1 Grade (for 2024-2025 school year)
*
Please select one option.
4/Preschool/Potty trained
PreK/Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Does Child #1 have allergies?
*
Please select one option.
No
Yes, I'll explain
Child #2 Name (First and Last)
Child #2 Grade (for 2024-2025 school year)
Please select one option.
4/Preschool/Potty Trained
PreK/Kindergarten
1stGrade
2nd Grade
3rd Grade
4th Grade
5th Grade
Does Child #2 have allergies?
Please select one option.
No
Yes, I'll explain.
Child #3 Name (First and Last)
Child #3 Grade (for 2024-2025 school year)
Please select one option.
4/Preschool/Potty Trained
PreK/Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Does Child #3 have allergies?
Please select one option.
No
Yes, I'll explain.
Child #4 Name (First and Last)
Child #4 Grade (for 2024-2025 school year)
Please select one option.
4/Preschool/Potty Trained
PreK/Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Does Child #4 have allergies?
Please select one option.
No
Yes, I'll explain.
How many will attend the Picnic on June 6?
*
Please select one option.
0, we are unable to attend.
1
2
3
4
5
6
Do you attend a church?
*
Please select one option.
No
Yes
Name of Church:
If you do not have a Bible in your home, would you like one?
Please select all that apply.
Yes, please!
No, thank you.
Submit
Description
Please fill out this form and click submit.
×
Please Fix the Following