Vacation Bible School

July 24th-28th

8AM-Noon

Kindergarten - 6th Grade

Register Today!

* Indicates required field

Number of Children Attending *

Child's Name *

First

Last

Birthdate & Grade Completed *

2nd Child's Name *

First

Last

2nd Child's Birthdate & Grade Completed *

For additional children - Name, Birthdate, & Grade completed for each *

Do they have any medical needs or dietary restrictions? *

Yes No

If yes, please explain. *

Parent/Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

2nd Parent/Guardian Name *

First

Last

2nd Parent/Guardian Phone Number *

Emergency Contact Name & Phone Number *

Name & Phone Number of Additional Person Authorized to Pick Up *

Submit

Please be sure to arrive 30 minutes early on the first day. See ya there!

If you have any further questions, please let us know by clicking one of the links below.

Email Joyce Jackson

Call Joyce Jackson