VACATION BIBLE SCHOOL 2017

Dates: June 19 - 23 (Monday-Friday)

Time: 8:30 am - 11:30 am

Ages:  PreK - 6th grade

VBS FAMILY NIGHT: June 25 (Sunday)| 6 pm

501-889-2015

VBS REGISTRATION FORM 2017

Child's Name *
Child's Name
Gender
Date of Birth
Date of Birth
School grade or stage COMPLETED *
If unsure, leave blank
Parent 1 Name (Required) *
Parent 1 Name (Required)
Parent 1 Relation To Child *
Parent 1 Phone Number *
Parent 1 Phone Number
Home Address *
Home Address
Parent 2 Name (Optional)
Parent 2 Name (Optional)
Parent 2 Relation to Child
Parent 2 Phone Number (Optional)
Parent 2 Phone Number (Optional)
Caregiver's Mobile Number (If different from parent/guardian)
Caregiver's Mobile Number (If different from parent/guardian)
Do you have a church home? *
If no, leave blank
If not, type N/A
Phone Number *
Phone Number