Scuba Vacation Bible School Registration

July 8 - 12 | 6 PM - 8:30 PM | Please fill out this form and click submit.

Parent/Guardian Information

A seperate form will need to be filled out for each child. If filling out a form for multiple children, Please ensure the Parent/Guardian name is filled in on each form, however you do not need to fill in the other parent information unless the information is different for the other children.

Parent/Guardian Name

*

Email

Phone

Address

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

Alternate Pickup Name

Home Church Affiliation

Participant Information:

Childs Name

*

Entering Grade

*

Please select all that apply.

PreK (potty trained ages 3, 4, & 5) Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 8 Grade 9

Gender

Please select all that apply.

Male Female

Childs Date of Birth

*

Allergies

Medical Concerns

Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1

Friend 2

Friend 3

Friend 4

Friend 5

Comments:

Description

July 8 - 12 | 6 PM - 8:30 PM

Please fill out this form and click submit.

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