2025 VBS Registration-Road Trip- June 2-5, 6:00-8:00pm

Please fill out this form and click submit. You may also register at the door.

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

*

Child #1 Name (First and Last)

*

Child #1 Grade (for 2025-2026 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 2025-2026 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 2025-2026 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 2025-2026 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 5?

*

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.

Description

Please fill out this form and click submit. You may also register at the door.

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