VBS Registration Form

To volunteer, please contact Jill at 662.934.7696, jillroberts22@gmail.com or call the church office at 662.563.7655.

Child's Name*
First Last
Parent's Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Child's Birthdate*
MM slash DD slash YYYY
Last grade completed in school
Medical Information
Medical or other information we need to know. (Please include any food allergies.)
Emergency Contacts (other than listed above)
Names & Phone numbers
Dismissal Information
Who may pick up your child at the end of each VBS day?
Does your child attend Sunday School?
- Yes
- No
Where does your child attend Sunday School?
If your child is visiting our church, who are they a guest of?
May we have permission to photograph your child?*
- Yes
- No
May we have permission to use your child’s photograph for the purpose of promotion?*
- Yes
- No
Email
This field is for validation purposes and should be left unchanged.