2021 VBS Kids Camp Registration
July 19th - 22nd / 6 - 8:30 pm | Please fill out this form and click submit.
Please complete a form for each child.
Once you submit a child's form it will give you the option to go back and enter another child.
You can pay full amount on one child's entry and check paid under sibling for the remainder of your children.
Child's Name
*
Mom's Name
*
Dad's Name
*
Email
*
This address will receive a confirmation email
Cell Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Age
*
Please select all that apply.
3 Years
4 Years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
Grade
*
Please select all that apply.
Pre-School (3yrs to 5 yrs)
Kindergarden
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Food Allergies / Medical Copnditions
*
I, the parent or legal guardian of above named child give my permission to use the photographs taken during VBS for but not limited to: publicity, illustration, advertising and web content.
*
Please select all that apply.
By checking this box I, the parent/guardian, give my permission for Grace to use photos taken during VBS as stated above
I, the parent/guardian, DO NOT give my permission for Grace to use photos taken during VBS as stated above
Parent / Guardian Name
*
Payment
1 Child after June 30th ($15)
Family (2+) - After June 30th ($30)
Scholarship Needed (0)
Paid under sibling ($0)
1 Child after June 30th ($15)
Family (2+) - After June 30th ($30)
Scholarship Needed (0)
Paid under sibling ($0)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
July 19th - 22nd / 6 - 8:30 pm
Please fill out this form and click submit.
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