VBS Pre-Registraion Form


2018 VBS

"Shipwrecked - Rescued By Jesus"

Date: Aug. 6th - Aug. 10th

Time: 6:30 PM - 8:45 PM



Child's' Name: 


Childs Age:   Childs Grade in Fall 2018:


Parents Names: 




City:  Zip:  E-mail:


Phone:  Work:  Cell:


Emergency Contact Person:


Emergency Contacts Phone:   Emergency Contacts Cell:


Church membership at:


Please list any medical/health conditions or allergies that we should be aware of:

Video/Photo & Activities Release: I hereby grant the VBS leaders permission to photograph/film the minor(s) designated above in any manner or form for any lawful purpose associated with this VBS program. I also grant permission for my child to participate in the fitness activities each night.

Signature of Parent or Guardian:  Date:

Fill Out Form And Print To Turn In:

Fill Out Form & Submit To VBS Director:


If you have any questions please e-mail Rev. Ellen Broome:

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