VBS Registration

VBS Registration Form
July 18 - 22
6:00pm - 8:30pm Nightly

To help us get an accurate count please make sure to fill this form out for each child you have coming to join us!

* Indicates required field

Child's Name: *

First

Last

Child's age: *

Child's Gender: *

Last School Grade Completed: *

Parent's Name: *

Physical Street Address: *

City: *

State: *

Zip Code: *

Primary Phone Number: *

Secondary Phone Number: *

Parent's Email Address: *

Home Church: *

Allergies, Medical Conditions, or Special Needs *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Contact's Relationship to Child *

Does Your Child Need a Ride Provided by the Church? *

No Yes

*If you marked yes, your child will be picked up in a van clearly marked with Church Logos on the side of the van.

Submit

Church Contact Information

Mailing Address:
P.O. Box 846
Wartburg, TN 37887

Physical Address:
308 N. Maiden St.
Wartburg, TN 37887

Church Phone Number:
423.346.3550

Senior Pastor E-mail:
[email protected]

Church Office E-mail:
[email protected]