2024 VBS REGISTRATION FORM

Registration is for ages 4 to 11 (Pre-K to 5th grade).

First Child

First Name

Last Name

Age

Please choose your child's age from the dropdown choices.

Second Child

Please add the name of a second child if applicable.

First Name

Last Name

Age

Please choose your child's age from the dropdown choices.

Third Child

Please add the name of a third child if applicable.

First Name

Last Name

Age

Please choose your child's age from the dropdown choices.

Parent's Names

First Name

Last Name

First Name

Last Name

Parent's Email

Parent's Phone

Please include an emergency contact phone number.

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Do any of the children have allergies we need to know about?

YES

NO

If YES, please provide additional information below regarding your children's allergies: If NO, please type "none".

Please provide below who will be picking up your children.

First Name

Last Name

Please provide a phone number for the person picking up your children.

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CHURCH LOCATION:

13885 US Hwy 301 N.
Parrish, FL 34219
United States of America