VBS Registration Form Student Name:* First Last Date of Birth:*01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201820172016201520142013201220112010200920082007200620052004200320022001daymonthyearLast Grade Completed:*Select grade9th8th7th6th5th4th3rdSpecial Needs/Allergies/Medical/Other Parent/Guardian Name:* First Last Address:* Street AddressCityState / Province / RegionPostal / Zip CodeWork/Cell Phone:* Area Code - Phone Number Home Phone: Area Code - Phone Number E-mail:Name of Home Church:SelectGWBBCOakey GroveMecedoniaMt. EnonJones CreeekOtherDo you consent to having your child's pictures/images posted during our church recognition, webpage and/or social media platforms?*YesNoSubmitResetWord Verification:
