Vacation Bible School Registration

Road Trip Vacation Bible School Sunday-Thursday, June 1-5, 2025

Name
This field is for validation purposes and should be left unchanged.
Children To Be Enrolled in Vacation Bible School*
Name * Medical Concerns (Y/N) ? Birthday Grade Just Completed
* Explain Allergies or other Medical Concerns
Parent Information
Parent Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Cell Phone
Email
Emergency Contact Information
Emergency Contact*
Name Phone
Doctor
Name Phone
Preferrred Hospital
Member of Christus Victor?*
- Yes
- No
Are you a member of another church? Which church?
Register by May 5th and Receive a VBS T-Shirt !!! (While supplies last)
T-Shirt sizes available are: (XS (2-4), S (6-8), M (10-12), L (14-16), XL (16+)
Child's Name T-Shirt Size
Registration Fee
$35 per child, maximum of $70 per family. Scholarships are available.
Payment Amount

Parent Information

Name	* Medical Concerns (Y/N) ?	Birthday	Grade Just Completed

Child's Name	T-Shirt Size