VBS 2023 Signup

VBS 2023 Registration

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Next Steps: Install a Payment Add-On

To accept payments on this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.

Contact Details

Child's Name(Required)

First Last

Parent/Guardian's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Mobile Phone(Required)

Work Phone

Enter Email Confirm Email

Child's Birth Date(Required)

Last Grade Completed(Required)

Medical or Other Information We Need to Know(Required)

Emergency Contact Information

Emergency Contact 1 Name(Required)

Emergency Contact 1 Phone(Required)

Emergency Contact 2 Name

Emergency Contact 2 Phone

Dismissal Information(Required)

Do You Regularly Attend Church?

Yes

If so, where?

How did you hear about our VBS?(Required)

May we have permission to use your child's photo for the purpose of promotion on our church website?(Required)

Yes