Rolling River Rampage   VBS Registration 2018

June 25-28th          6:00 -8:15pm               
For all children ages 4K-Rising 5th Grade
 
Please complete a  separate form for each child

Child's Name (required)

Select Gender (required)

Parent's Family Guardian Name (required)

Address (required)

City (required)

Zip Code (required)

Your Email (required)

Phone Number (required)

Date of Birth (required)

Child's Age (required)

Last Grade Completed (required)

Home Church (required)

Allergies (if any)

Emergency Contact Name (required)

Phone Number (required)

Dismissal: Name(s) of person(s) who may pick this child up from VBS (required)

Any additional information you would like to provide

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