2022 Vacation Bible School

Pre-Registration for Vacation Bible School 2022

First Name*

Please enter the registrant's first name.

Last Name*

Please enter the registrant's Last Name.

Street Address*

Please enter your Street Address.

City*

Please enter your City.

Phone Number*

Please enter a valid phone number (123-456-7890).

Date of Birth*

/ / Please enter the registrant's birthday.

Zip Code*

Please enter your Zip Code.

Email*

Please provide your email address.

Age as of July 1st*

Please enter child's age.

School Grade Completed*

Please choose the most recent school grade completed.

Name of church attended

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Name of Parent(s)*

Please enter the name of the child's parents.

Need a ride?*

Please indicate if a ride is required for the child to attend.

Pickup location

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Allergies or Special Diet Instructions?*

Please indicate if the child has any allergies or special diet needs. If no exist, please type N/A.