VBS is for children ages 4 - rising 5th graders.

Monday, June 24 - Thursday, June 27
5:30 - 7:30 p.m.

Dinner will be served before VBS at 5:00 p.m.

Please fill out the items below.

Child's Name

First Name

Last Name

Child's Age

Date of Birth

YYYY

Please list any allergies, medical conditions, or special needs

(If there are none, please type NONE.)

Last school grade completed

Parent/Guardian Name

First Name

Last Name

Parent/ Guardian Cell Number

(###)

###

####

Parent/Guardian Email

Emergency Contact Name

First Name

Last Name

Emergency Contact Cell Number

(###)

###

####

Relationship to child

Will your child be joining us each night for dinner?

Yes