In The Wild Registration Form
We are excited about the opportunity to spend a week with your child "In The Wild" exploring God's Word as we have Amazing Encounters with Jesus. Please provide the necessary information to complete the following form. Come join us as we Zoom in and Focus on Jesus!
Child's Name*
Home/Cell Phone*
Work Phone
Age Information
[Child must be 4 on or BEFORE Sept. 1, 2018]
Birth Date*
Last grade completed in school*
Medical Information
Medical or other information we need to know. Please include any allergies.*
Emergency Contacts
ER Contact 1 Name*
ER Contact 1 Phone Number*
ER Contact 2 Name
ER Contact 2 Phone Number
Dismissal Information
Who may pick up your child at the end of each VBS day?*
Other Information
Does your child attend Sunday School?*

If so, where?
If your child is visiting, with whom did he/she come?
May we have permission to photograph your child?*

May we have permission to use your child's photograph for the purpose of promotion?*