VBS Registration Form
1300 Kishwaukee Valley Road
Woodstock, IL 60098
Fax: 338-0913


Please complete a separate form for each child who will be attending. There is a suggested donation of $20 per child, with a maximum of $50 per family. Children receive all materials for the week plus will bring home a CD with all their favorite VBS songs at the end of the week.
July 17 - 21, 2017 9 a.m. - 12 noon


-CarrieFiorina, Director of Education Ministries

All fields with an "*" must be filled out below before pressing the submit button.

*Child's Name First:


NickName: (perferred name to be called)

*Street Address:


Child Shirt Size:

*Male/Female: *Telephone(Home):

*Grade entering in fall: *Date of Birth:

*In case of emergency, contact name:

*Emergency Contact Phone:

Mother/Guardian Name:

Mother/Guardian Phone: Cell:

Father/Guardian Name:

Father/Guardian Phone: Cell:

Allergies or other medical conditions:
(Please use the enter key to create line breaks.)

Special Education needs:
(Please use the enter key to create line breaks.)

Home Church(if any):

If attending with a non-member friend, please list the friend's name: