All fields are required to have a response.  If you wish to leave an entry blank please type a / in the box.

Emergency Contact Phone
Child's Allergies Or Medical Conditions / if NONE please enter none.
Mom / Guardian's Cell Phone
Home Phone
Person other than parent authorized to pick up your child
Church That Student Regularly Attends
Parent/Guardian Name
Dad / Guardian's Cell Phone
Dad / Guardian's Work Phone
Mom / Guardian's Work Phone
Emergency Contact (Other Than Parents)
Child's Name
The information above will be transfered to a form that includes the following statement which you will have to sign the first time you bring your child to Vacation Bible School.
​Thank you for taking the time fill out our form, we look forward to having your child at our Vacation Bible School