VBS Registation

Child Information

Child Name

Date of Birth

Last Grade Completed

Address

Allergies/Medical Concerns

This address will receive a confirmation email

I would like more information about Fellowship Church Yes

Primary Emergency Contact

Emergency Contact (First and Last Name)

Phone

Relationship to Child

Secondary Emergency Contact

Emergency Contact (First and Last Name)

Phone

Relationship to Child

Description

July 21 - July 25

Please complete a separate form for each child.