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 (one per child) completed K - completed Grade 6
VBS Splash In is Friday, June 21, 5:30 - 7:30 P.M.
VBS is June 24-27, 9:15 A.M.-12:00 NOON 


Child's Name* 

Child's Gender

Child's Age

Date of Birth

Last School Grade Completed

Name of Parents (s)

Street Address

City, State, Zip

Home Telephone

Parent/Caregiver's Cellphone

Home Email Address

Home Church

Allergies, Medical Conditions, or Special Needs

In Case of Emergency, Contact Name(s)

Phone of Emergency Contact(s)

Relationship to Child

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