VBS 2018 Registration Form

Ages: Kindergarten - 6th Grade

Monday, June 18- Thursday, June 21

5:30 pm - 8:00 p.m.

Dinner will be served.

Church Phone: 479-442-5267


Name of Child(ren) Required

Name of Parent(s)/Guardian(s) Required

Address Required

Emergency Contact Name and Phone # Required

School Grade Completed Required

Health Information (Allergies, Medications, or Special Instructions)

Please list other persons who have permission to pick up your child(ren)

Do we have permission to include your child's picture in a slideshow on Thursday? Required