STELLAR VBS REGISTRATION FORM

June 12-16, 5:30-8:00pm | Please fill out this form and click submit. One form per child will need to be filled out. This year our VBS will be in person, ages 5 through 12 and a separate Middle School group! Registration closes June 11, 2023.

Child's Name

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Parent or Guardian's Name (first & last)

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Parent or Guardian's Email

*

This address will receive a confirmation email

Parent or Guardian's Phone

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Address

*

Child's Age

*

Child's Birthdate

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Child's Grade (2023-2024 School Year)

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Please select one option.

Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

Allergies, Medical Conditions, or Special Needs

How did you hear about this VBS?

*

Please select all that apply.

Church Sign Door hanger Social Media Other

I give permission for pictures taken of my child during VBS to be used for illustration, spotlight summary videos, and web content.

*

Please select all that apply.

Yes No

Request for my child to be in the same group as:

Emergency Contact Information

Emergency Contact

*

Emergency Contact Phone

*

Relationship to Child

*

Description

June 12-16, 5:30-8:00pm

Please fill out this form and click submit. One form per child will need to be filled out. This year our VBS will be in person, ages 5 through 12 and a separate Middle School group! Registration closes June 11, 2023.

Please Fix the Following

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