2018 VBS Student Registration - Shipwrecked
2018 VBS Student Registration - Shipwrecked
Child's first name  * 
Child's last name  * 
Student's age  * 
Student's date of birth  * 
Home telephone #  * 
Your Email Address  * 
Child's grade for the 2018-2019 school year?  * 
Mailing address  * 
Parent's/ Caregiver's name(s)  * 
Parent's/ Caregiver's cell phone  * 
Parent's/ caregiver's cell phone (if additional)
Home church
Allergies or medical conditions  * 
My child requires an epi pen.  * 
Emergency contact if parent/ caregiver can not be reached  * 
Emergency contact phone number  * 
Alternate pick-up name  * 
Alternate pick-up phone #  * 
Is there a friend your child would like to be with in the same class?
Do you want to purchase a shirt?  * 
Interested in purchasing a VBS CD?  * 
Total $
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