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VBS Enrollment
Please fill out the required fields to enroll your child(ren) to Vacation Bible School.
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Child's Name (must be at least 4yrs old)
*
First
Last
Grade Completed
*
If other, please specify:
pre-school, kindergarten, etc.
Parent/Guardian's Name
*
First
Last
Parent/Guardian's Phone Number
*
Parent/Guardian's Email
*
Relationship to Child
*
Select (1) from the dropdown list.
Parent
Sibling
Grandparent
Extended Family
Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact's Name
*
First
Last
Emergency Contact's Phone Number
*
Emergency Contact's Email
*
Allergies?
*
Yes
No
If yes, please list:
*
Medical Concerns?
*
Yes
No
If yes, please list:
*
Submit