RED BRICK CHURCH VBS REGISTRATION 2025

June 16 - 20 from 9 to 11:30 am | Please fill out this form and click submit.

PLEASE NOTE:
(For preschool children, they must be 4 years of age and potty trained to attend VBS. Thank You.)

Name (of child)

*

Gender

*

Please select one option.

Male Female

Address

*

Home Phone

Mobile Phone

*

Ok to text?

Please select all that apply.

Yes No

Email

*

This address will receive a confirmation email

Birthdate (PLEASE type as MM/DD/YYYY)

*

School

Please select one option.

Stillman Valley Byron Rockford Oregon Other

Grade child completed in May/June 2025.

*

Please select all that apply.

Preschool Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade

Please List any Allergies/Diet Restrictions

Special Needs

Emergency Contact Name

*

Emergency Contact Number

*

All people authorized to pickup child

*

Home Church

*

Do you agree to allow photos of your child to be used in church presentation or church promotional materials?

*

Please select all that apply.

Yes No

Description

June 16 - 20 from 9 to 11:30 am

Please fill out this form and click submit.

PLEASE NOTE:
(For preschool children, they must be 4 years of age and potty trained to attend VBS. Thank You.)

Please Fix the Following

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