VBS 2023 Registration Form

Please fill out ONE FORM PER CHILD to register for VBS 2023 at CVBC.

Child's Name*

First Name

Last Name

Child's Gender*

Male Female

Child's Age*

Grade Completed*

Child's Date Of Birth*

Parent's Name(s)*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Parent/Guardian's Primary Phone*

Parent/Guardian's Secondary Phone

Parent/Guardian's Primary Email*

Do you and/or your child attend CVBC?*

Yes No

Other:

If you attend another church, choose other, and write the name of the church.

Allergies Or Other Medical Conditions*

If none, write, "None"

Emergency Contact's Name*

First Name

Last Name

Emergency Contact's Primary Phone*

Emergency Contact's Relationship To Child*