VBS Registration

Vacation Bible School

* Indicates required field

Students Name *

First

Last

Age *

Grade Completed *

Birthdate *

Parents Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent Phone Number *

Emergency Contact *

First

Last

Emergency Phone Number *

Relationship to student *

Food Allergies *

Medical Concerns *

Doctor *

Doctor Phone Number *

Siblings Attending VBS (names & ages) *

Free T-Shirt *

Child X-Small Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large Adult XXX-Large

Church Membership at *

I understand my child's picture may be taken and could be used in a VBS newsletter or in local newspapers. *

Yes

Submit

26555 Brickville Rd. Sycamore, IL 60178 (815) 895-4477