VBS 2024 REGISTRATION

2024 VBS Registration Form "Seekers in Sneakers Discover Jesus"

* Indicates required field

Each Child's Info - Name (First & Last); Age; Last Grade Completed EXAMPLE: Jane Doe; 7 years old; 2nd grade *

Parent/Guardian Name(s) *

First

Last

Parent/Guardian Email *

Address *

Home/Cell Phone *

Alternate Phone *

Emergency Contact Info (Names and Phone numbers) *

Allergies, Medications, and/or Medical Conditions *

Medical Insurance Information: Coverage? Yes/No, Insurance Company Name; Policy/Group ID# *

Any activity restrictions? *

People authorized to pick up my child *

Submit