Vacation Bible School Registration

Vacation Bible School Registration Form
One Per Child

Child's name:

Child's gender:

Child's age:

Date of birth:

Last school grade completed:

Parent's name:

Street address:

City:

State:

Zip:

Home telephone:

Parent/caregiver's cellphone:

Home email address:

Home church:


Allergies or other medical conditions:

In case of emergency, contact:

Phone:

Relationship to child:

**If you do not receive a confirmation email, please contact the church office 724-924-2161.