VBS Family Registration


VBS Family Registration
July 10—July 14
9:00 a.m. to 12:00 p.m.
VBS is for children ages K - 6th (2017-18 school year)


Please complete the entire form and then click submit.
Your child(ren) are not registered until you click submit.




Parent / Guardian 1

 

First Name (*)

Invalid Input
Last Name (*)

Invalid Input
Home Phone (*)

Invalid Input
Cell Phone (*)

Invalid Input
E-mail Address (*)

Invalid Input

Parent / Guardian 2

 

First Name

Invalid Input
Last Name

Invalid Input
Home Phone

Invalid Input
Cell Phone

Invalid Input
E-mail Address

Invalid Input

 

Street Address (*)

Invalid Input
City (*)

Invalid Input
State (*)

Invalid Input
Zip Code (*)

Invalid Input
Emergency Contact Name (*)

Invalid Input
Emergency Contact Cell Phone (*)

Invalid Input
Home Church (*)

Invalid Input
How did you hear about VBS?

Invalid Input

 

You have the ability to register up to 4 children at one time.
Please complete all information for each child.



First Child

 

Child's First Name (*)

Invalid Input
Child's Last Name (*)

Invalid Input
Gender (*)

Invalid Input
Age as of June 1 (*)

Invalid Input
Child's Birthday (mm/dd/yyyy) (*)

Invalid Input
Grade ENTERING in the Fall (*)

Invalid Input
Allergies or other medical conditions we should be aware of?

Invalid Input
Special friend to be with:

Invalid Input Special friend MUST be in the same grade.

Can this child's photo be used at Riva Trace Baptist Church for promotion? (*)

Invalid Input
Can this child's photo be used in public publications for promotion (newspapers', etc.)? (*)

Invalid Input

Second Child

 

Child's First Name

Invalid Input
Child's Last Name

Invalid Input
Gender

Invalid Input
Age as of June 1

Invalid Input
Child's Birthday (mm/dd/yyyy)

Invalid Input
Grade ENTERING in the Fall

Invalid Input
Allergies or other medical conditions we should be aware of?

Invalid Input
Special friend to be with:

Invalid Input Special friend MUST be in the same grade.

Can this child's photo be used at Riva Trace Baptist Church for promotion?

Invalid Input
Can this child's photo be used in public publications for promotion (newspapers', etc.)?

Invalid Input

Third Child

 

Child's First Name

Invalid Input
Child's Last Name

Invalid Input
Gender

Invalid Input
Age as of June 1

Invalid Input
Child's Birthday (mm/dd/yyyy)

Invalid Input
Grade ENTERING in the Fall

Invalid Input
Allergies or other medical conditions we should be aware of?

Invalid Input
Special friend to be with:

Invalid Input Special friend MUST be in the same grade.

Can this child's photo be used at Riva Trace Baptist Church for promotion?

Invalid Input
Can this child's photo be used in public publications for promotion (newspapers', etc.)?

Invalid Input

Fourth Child

 

Child's First Name

Invalid Input
Child's Last Name

Invalid Input
Gender

Invalid Input
Age as of June 1

Invalid Input
Child's Birthday (mm/dd/yyyy)

Invalid Input
Grade ENTERING in the Fall

Invalid Input
Allergies or other medical conditions we should be aware of?

Invalid Input
Special friend to be with:

Invalid Input Special friend MUST be in the same grade.

Can this child's photo be used at Riva Trace Baptist Church for promotion?

Invalid Input
Can this child's photo be used in public publications for promotion (newspapers', etc.)?

Invalid Input