VBS Registration Form
Required fields marked with an asterisk (*)
General contact info
Parent/guardian name
*
Home phone
*
Work phone
Cell phone
Address
*
City
*
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
*
Zip code
*
Email address
Emergency contact(s)
Contact name 1
*
Phone number 1
*
Contact name 2
Phone number 2
Dismissal information
Who may pick up your child
at the end of each VBS day?
*
Other information
Do you attend Sunday School
or church?
Yes
No
If so, where?
If you are visiting our church,
who are you a guest of?
May we have permission to:
Photograph your child(ren)?
Yes
No *
Use your child(ren)'s photograph
in church publications for the
purpose of promotion?
Yes
No *
Child(ren)'s information
How many children
are you registering?
0
1
2
3
4
5
6
7
8
9
10
<-- Select to continue
*