VBS Registration

Children ages 4 through 6th grade are invited to attend our Vacation Bible School program! Childcare for children ages 0-3 is only provided for VBS staff/volunteer families. For more information on volunteer opportunities, see the Volunteer Form.

Please fill in the form below to register for Vacation Bible School:

Children's Information

Note:

Do you have multiple chilren to register? If so, don't fret! Use the "Submit & Add Another Child" button at the bottom of the form. We will pre-fill the form with your registration information.

Child's First Name:

Child's Last Name:

Last Grade Completed:

Birthdate:

(mm/dd/yyyy, i.e. 01/01/2005)

Medical/other information we need to know. Please include food allergies:

Maximum length of 150 - 200 words

Tribe/Friend Preference:

Parent's Information

Parent/Guardian Full Name:

Address:

City:

State:

Postal Code:

Primary Phone:

format: 555-555-5555

Secondary Phone:

format: 555-555-5555

Alternate Phone:

format: 555-555-5555

Email:

If you don't have an email address, please contact the church office to register (502-897-1771).

Emergency Contact

Name:

Primary Phone:

format: 555-555-5555

Alternate Phone:

format: 555-555-5555

Dismissal Information

Who may pick up your child?:

Who may NOT pick up your child?:

Other Information

Do you attend church?:

If yes, where?:

If you are bringing a guest(s) to VBS, please list their names(s):

Please Note:: Each of your guests must also complete the Registration Form.

* indicates a required field