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Register for Vacation Bible School
(*) Denotes required field
*Name
*Age
  *Date of Birth (mm/dd/yy)
*Gender
  *Grade entering
*Parent/Guardian
Location, if in building
Address
City
State
     Zip

Phone Information - at lease one required
Home Phone
  Cell Phone

Emergency Contact
*Name
  *Phone:
Location, if in building

Additional Information
Church child attends
Invited by
Place at table with:
Allergies/ Special Medical Instructions
Can be picked up by:
Payment Information
Payment to be received at beginning of program
LBC Attendee - $10/Child; $30 limit/family
Visitor - Free
Scholarship
 
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