VBS Participant Registration

We can't wait to see you at VBS!

See you soon!

Parent/Guardian Information

Parent/Guardian First Name

*

Parent/Guardian Last Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Child 1

1st Child's First and Last Name

*

1st Child's Birthdate

*

1st Child's Gender

*

Please select all that apply.

Male Female

Last Grade Level Completed

*

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th

Friend Request: Please list the name of the child you'd like your child to be placed with (honored based on space availability, must be no more than 1 grade above or below your child's grade).

Any allergies, medical conditions, or special needs we should be aware of?

*

Child 2

2nd Child's First and Last Name

2nd Child's Birthdate

2nd Child's Gender

Please select all that apply.

Male Female

Last Grade Level Completed:

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th

Friend Request: Please list the name of the child you'd like your child to be placed with (honored based on space availability, must be no more than 1 grade above or below your child's grade).

Any allergies, medical conditions or special eneds that we should be aware of?

Child 3

3rd Child's First and Last Name

3rd Child's Birthdate

3rd Child's Gender

Please select all that apply.

Male Female

Last Grade Level Completed:

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th

Friend Request: Please list the name of the child you'd like your child to be placed with (honored based on space availability, must be no more than 1 grade above or below your child's grade).

Any allergies, medical conditions, or special needs that we should be aware of?

Child 4

4th Child's First and Last Name

4th Child's Birthdate

4th Child's Gender

Please select all that apply.

Male Female

Last Grade Level Completed:

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th

Friend Request: Please list the name of the child you'd like your child to be placed with (honored based on space availability, must be no more than 1 grade above or below your child's grade).

Any allergies, medical conditions, or special needs that we should be aware of?

Child 5

5th Child's First and Last Name

5th Child's Birthdate

5th Child's Gender

Please select all that apply.

Male Female

Last Grade Level Completed

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th

Friend Request: Please list the name of the child you'd like your child to be placed with (honored based on space availability, must be no more than 1 grade above or below your child's grade).

Any allergies, medical conditions, or special needs that we should be aware of?

Emergency Contact/Miscellaneous

First and Last Name of Emergency Contact

*

Phone Number of Emergency Contact

*

Please list anyone who has permission to pick up your child.

*

May we have permission to photograph your child for daily recap videos?

*

Please select one option.

Yes No

If you currently attend a church, where do you attend?

*

Would you like to be added to our Berean Friends email Newsletter to keep up to date with all of the activities at Berean?

*

Please select all that apply.

Yes No

Anything else you'd like us to know?

Description

We can't wait to see you at VBS!

See you soon!

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