Welcome to VBS registration for children age 5 (by July 23).

Please remember that payment is required to complete registration.

Child's Name *
Child's Name
Child's Gender *
Birthdate *
Birthdate
Child's Home Address *
Child's Home Address
Child's Home Phone *
Child's Home Phone
If none, please enter cell.
Contact Parent *
Contact Parent
Contact Parent's Cell Phone *
Contact Parent's Cell Phone
Spouse's Full Name (or N/A) *
Spouse's Full Name (or N/A)
Spouse's Cell Phone
Spouse's Cell Phone
If applicable
Emergency Contact *
Emergency Contact
Other than parent.
Emergency Contact Phone *
Emergency Contact Phone
Other than parent.
Enter none if no home church.
Child's T-Shirt Size *
Does your child have any special needs? *
I verify my child is (as of July 23) *
We need your help! Please consider helping in one of the following ways: *