VBS 2024 Family Registration

Family Last Name *

Parent's First Name(s) *

Street Address *

City & Zip Code *

Cell Phone Number *

Parent Email Address *

Where is your church home? *

South Church

I don't have a church Home

My church home is... My church home is...

Would you like more information about South Church? *

YES

No thank you

Were you invited by a friend? *

YES

NO

Who was it that invited you? Please include first and last name *

Name and phone number of person bringing and picking up child (if different from above) - this is for check-in purposes, so you (and us) know which phone number to use at the kiosk. *

How many kids are you registering? *

Child #1

Child's Name #1 (include last name if different from above) *

Boy or Girl? *

Grade/Age?
For elementary, select GRADE JUST COMPLETED.
We offer nursery-PreK programs for those serving in the building ONLY. If you select nursery - PreK, please also submit a worker registration form. *

Birthdate MM/DD/YY *

Special needs, allergies or medical concerns? If so, please list them. *