Student's Info
Student's Full Name
Date Of Birth
Please select the grade your child will be going into for the 2016-2017 school year.

Parent's Info
Parent's Full Name
Home Phone
Cell Phone
Home Church
Email Address
This is only so we can send you confirmation. It's kept strictly private and not shared with anyone.
Emergency Contact Information
In the event of an emergency with your student, during VBS, please provide an alternate contact for your child. This will be used in the event you are unreachable.
Contact Name
Contact Number
If for some reason you do not receive a confirmation email immediately,
please check your spam or junk mail folder in your email client.