2016 Vacation Bible School (Preschool & Kindergarten)
Red asterisk = a required field
Registration for VBS is closed but you are welcome to get on our waiting list. If a space becomes available we will contact you. Please mark "yes" to indicate that you understand you are getting on the VBS waiting list. Please do not pay any fees unless you are contacted that a space opened up.*
 No
 Yes
Parent/Guardian First Name*
Parent/Guardian Last Name*
Participant First Name*
Participant Last Name*
Gender*
 Male
 Female
Date of Birth (MM/DD/YYYY)
Address*
City, State Zip*
Contact Phone 1*
Contact Phone 2*
Parent/Guardian Email*
Grade Entering in the Fall*
Allergies (please list all separated by commas); if none, enter N/A*
Medical Issues; if none, enter N/A*
Emergency Contact Name*
Emergency Contact Phone*
Emergency Contact Relationship*
Alternate Pickup Name*
Alternate Pickup Phone*
Additional Comments
T-shirt size (example 3T or 7)*


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