Name *

First

Last

Email *

Phone

Address

City, State Zip

Age Range19 & Under20's30's40's50's60+

Additional Family Member Names & Ages

What brought you our way? (select all that apply)Looking for a church homeLooking for a church homeNew to the areaExploring my faithGuest of a friendTraveling, have a church homeOther

How have you joined us?In PersonOnline

Can we pray for you?

Our leaders pray often for each request and they will remain private unless requested. Please share any prayer needs you have.

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We invite you to Vacation Bible School to learn the ways Jesus makes us confident and capable when navigating a tricky world.

To register complete the form below or call us at 830.833.4884!

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Parent First Name

Parent Email *

Emergency Contact First & Last Name

How many children will you be registering today?12345

Parent Last Name

Parent Phone (cell phone if available)

Emergency Contact Phone

I am interested in volunteeringYes-I can help during VBSYes-I can help with setup/breakdownYes-I can help supply supplies or snacksNo-I can't volunteer at this time

Child 1

Child 1 Name *

First

Last

Child 1 Grade

• Pre-K
• 1
• 2
• 3
• 4
• 5

Child 2

Child 2 Name *

First

Last

Child 2 Grade

• Pre-K
• 1
• 2
• 3
• 4
• 5

Child 3

Child 3 Name *

First

Last

Child 3 Grade

• Pre-K
• 1
• 2
• 3
• 4
• 5

Child 4

Child 4 Name *

First

Last

Child 4 Grade

• Pre-K
• 1
• 2
• 3
• 4
• 5

Child 5

Child 5 Name *

First

Last

Child 5 Grade

• Pre-K
• 1
• 2
• 3
• 4
• 5

Any special instructions? (please put the child's name next to the needed instructions)

The following person(s) will be allowed to pick up the child(ren)

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