Delta VBS 2019

If you are registering a church and not children YOU MUST enter N/A in the child's First and Last name, as well as in the Emergency Contact information listed below! They are required fields.

Primary Child's Name

Primary Child's Age

Church

Additional Children's (First & Last) Names and Ages

This address will receive a confirmation email

Home Phone

Mobile Phone

Mailing Address

Emergengy Contact

Contact's Phone

Allergies (Please Specify which Child)

Churches who are contributing ($125) and have no children, as well as those requesting FINANCIAL ASSISTANCE, please proceed to "Payment" and choose the appropriate checkout box.

Payment

Please Designate who May pick up your child if you cannot:

I Might be available to volunteer at VBS YES

I give permission for my child/ren to be photographed during the week of VBS.

YES NO

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Delta VBS 2019

Description

Please Fix the Following