VBS Registration

Child 1 *

First

Last

Gender-Child 1 *

Male Female

Child 1 DOB (mm/dd/yyyy) *

Child 1 Last Grade Completed *

Child 2 *

First

Last

Gender - Child 2 *

Male Female

Child 2 DOB (mm/dd/yyyy) *

Child 2 Last Grade Completed *

Child 3 *

First

Last

Gender - Child 3 *

Male Female

Child 3 DOB (mm/dd/yyyy) *

Child 3 Last Grade Completed *

Child 4 *

First

Last

Gender - Child 4 *

Male Female

Child 4 DOB (mm/dd/yyyy) *

Child 4 Last Grade Completed *

Primary Guardian's Name *

First

Last

Primary Guardian's Phone Number *

Primary Guardian's Relationship to Child *

Primary Guardian's Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Mailing Address (if different) *

Line 1

Line 2

City

State

Zip Code

Country

Does your child attend Sunday School? If so, where? *

If your child is visiting our church, whom is he or she a guest of? *

Person(s) other than parents/guardians allowed to pick up child from VBS (list full name and phone number) *

Additional Guardian's Name *

First

Last

Additional Guardian's Phone Number *

Additional Guardian's Relationship to Child *

Additional Guardian's Email *

May we have permission to photograph your child? *

Yes No

May we have permission to use your child's photograph for the purposes of promotion? *

Yes No

Check this box to confirm that the above information is accurate and your child has permission to attend Vacation Bible School at ACC. *

I Confirm

Will you & your family be attending our VBS Family Celebration on Sat, July 23rd? If so, please indicate number attending below. *

Do you have any additional questions for us? *

Email or Phone Number for Additional Questions *

Vacation Bible School Child Registration Form

Medical Information

Other Information

If you have trouble with the online registration, please call the Ginger (785) 969-4285 and leave a message with a "best time to call". Your call will be returned and we will get your child registered.