Come join us for our VBS adventure June 4-9 from 6:30-9! If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. Child's First Name * Child's Last Name * Address 1 * Address 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Child's Age * Child's Date of Birth * Allergies Grade just completed in school * N/A PreK K 1 2 3 4 5 6 7 8 9 10 11 12 Parent's Email * Mother's Name * Mother's Cell Phone * Father's Name * Father's Cell Phone * Who is authorized to pick child up? * Is it OK to photograph your child? Is it OK to put child's photo on social media and our website? Do you attend church? Would you like to know more about our church? How many family members will attend Family Night on Friday, June 9, 2023 at 6:30pm? *
