VBS Registration

Child's First & Last Name
Grade Completed as of June 2017
Child Birth Date
Name of Parent(s) or Gaurdian
During the week we will be taking videos of the children as they play and learn. At the Friday Celebration Service, you’ll see the kids in action on video. Do we have permission for your child to be in a video?
- Yes
- No
Email
Street Address
City, State, Zip
Home Phone
Cell Phone
Home Church
Allergies or other medical conditions
Emergency Contact Name, Number, Relationship to Child
Submit registration

Thank you for registering. We can't wait to go on this adventure!

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Christian Assembly