Fiercely Faithful VBS 2023

You may fill out the registration form online or print and bring the completed form to the first day of VBS.

Child's Name

Child's Nickname

Child's Age

Child's Date of Birth

Name of Parent/Guardian

Street Address

City

State

Zip Code

Parent/Guardian's Cell Phone Number

Parent/Guardian's Email Address

Custodial Arrangement if applicable:

Child's allergies or other medical conditions (i.e. diabetes):

In case of emergency, contact:

Emergency Contact's Phone Number

Relationship to Child:

I give permission to call 911 in case of emergency

YES NO

Photographs will be taken during VBS. My response below indicates I am giving permission for my child's photo to be taken.

YES NO

If you would like to share any information regarding your child's special needs, please specify in the space provided: