VBS 2017 Registration Form

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Online Registration Form

Please com­plete one reg­is­tra­tion per child

Child’s Name*: 

Child’s Age* Child’s Grade in Fall:

Aller­gies or oth­er med­ical con­di­tions:

Is the child bap­tized? YesNo

Did the child attend ORLC VBS last year? YesNo

Home Church of child: 

Please check all days attend­ing:

Parent’s Name*: 
Email address*: 

Address*: Apart­ment #:
City*: State*: Zip*: 

Phone Num­ber:
Cell Phone Num­ber:

Emer­gency Con­tact #1*:
Emer­gency Phone Num­ber #1*:

Emer­gency Con­tact #2*:
Emer­gency Phone Num­ber #2*:

Chil­dren may be released to*:

How did you hear about ORLC VBS?
Fam­i­ly or FriendPosterPost­card mail­erOth­er

* Required Infor­ma­tion