Register Your Child

For Ages: 4 years - going into 6th grade.

NO REGISTRATION FEE

5:00 - 7:30 p.m.

Monday, June 17 - Wednesday, June 19 with a Family Celebration Thursday, June 20.

Additional Items to Note:

Optional dinner from 5:00-5:30 (Monday-Wednesday)
Please also bring donations of canned goods for Caring Hands throughout the week!
Please provide a plain white T-shirt for students on Monday June 17.

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):

Thank you for registering. We will follow-up with you as VBS approaches.: