Vacation Bible School Registration June 18th - 21st6:00 p.m. – 9:00 p.m.Tuesday - Friday Registration Cost $50 per child Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.LayoutFull Name of Student *Gender *MaleFemaleParent/Guardian Name *Email *EmailConfirm EmailAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeChild DataDate of BirthAgeLast School Grade CompletedMain Contact No.Contact Numbers (copy)HomeMobileWorkMedical InformationLayoutFamily PhysicianPhoneAllergies/Medical Information (Allergies to Food, Medicine, Bees, etc or Conditions)Current Medication(s)In the event of an emergency, Dayspring Family Fellowship has my permission to obtain Emergency Services.LayoutEmergency Contact 1PhoneEmergency Contact 2PhoneDismissal InformationName(s) of person(s) who may pick up this child from Vacation Bible School each dayLayoutPickup Person Name 1PhonePickup Person Name 2PhoneStudent T-Shirt InformationT-Shirt TypeAdultYouthT-Shirt SizeX-SmallSmallMediumLargeX-LargePlease verify you are not a bot *What is 10+1? Submit Form
