Register Your Child

Whoever gets the most friends to register and attend this years VBS will recieve a $50 gift card to "Learning Express". Make sure your friends write a note on registration stating that you recommnded that they join us.

We found some errors when you submitted your information. Please see below and fill in the information needed.

Parent Personal Information

Parent First Name:

Parent Last Name:

Address 1:

Address 2:

City:

Country:

State:

Zip:

Email:

Re-Enter Email:

Home Phone Number: (xxx-xxx-xxxx)

Cell Phone Number: (xxx-xxx-xxxx)

Other Phone Number: (xxx-xxx-xxxx)

Emergency Contact

Emergency Contact First Name:

Emergency Contact Last Name:

Emergency Phone 1: (xxx-xxx-xxxx)

Emergency Phone 2: (xxx-xxx-xxxx)

Alternate Pickup First Name:

Alternate Pickup Last Name:

Alternate Pickup Phone: (xxx-xxx-xxxx)

Other Information

Home Church (If Applicable):

Please let us know of any allergies or medical concerns.: