VBS Registration

Registration is $12 per child and includes all VBS activities and snacks. Payment must be brought to the Central Community Church office, mailed no later than Monday, June 15th or paid at the VBS booth on Sundays. VBS is open to all Preschool (3's & 4's - if potty trained) aged children through 6th grade.

* Indicates required field

Parent Name *

First

Last

Address *

City *

State *

Zip *

Home Number *

Parent/caregiver cell number *

Email *

Home church *

Emergency Contact

Name *

First

Last

Phone Number *

Child 1

Name *

First

Last

Choose One *

M F

Age *

Last grade completed *

Date of birth *

Allergies or medical conditions *

Child 2

Name *

First

Last

Choose One *

M F

Age *

Last grade completed *

Date of birth *

Allergies or medical conditions *

Child 3

Name *

First

Last

Choose One *

M F

Age *

Last grade completed *

Date of birth *

Allergies or medical conditions *

Child 4

Name *

First

Last

Choose One *

M F

Age *

Last grade completed *

Date of birth *

Allergies or medical conditions *

Child 5

Name *

First

Last

Choose One *

M F

Age *

Last grade completed *

Date of birth *

Allergies or medical conditions *

Make Checks Payable to Central Community Church

I Will Pay *

With Check Online Cash

Is there anythig we need to Know about your child *

I agree to receiving marketing and promotional materials

Register

Pay here

$12 per child