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