Preschool VBS

Emmanuel is offering VBS from 8am-11:30am on June 5-9, 2023. This is for boys and girls age birth through Kindergarten.

Please complete the form below to submit your registration.

Child's Name*
First Last
Child's Gender*
Child's Date of Birth*
Month
Day
Year
Child's Age*
Child's T-shirt Size*
Father's Name*
First Last
Mother's Name*
First Last
Legal Guardian's Name*
First Last
Home Phone Number*
Cell Phone Number*
Work Phone Number*
Email Address*
Emergency Contact - Name*
First Last
Emergency Contact - Phone Number*
Address*
Street Address Address Line 2 City State ZIP Code
Do any of the following health history related items apply to your child? (Please select all that apply)*
- Allergy
- Chronic Asthma
- Diabetes
- Drugs
- Epilepsy
- Frequent Colds
- Frequent Stomach Upsets
- Heart
- Insect Stings
- Physical Handicap
- Other
- None of these apply
Are there any special concerns or circumstances you would like your child's team leader to be aware of prior to your student's arrival at VBS?*
If yes, please explain*
Do you aknowledge that EBC has permission to use any image of your child made with others at camp or any written material that he/she may write about camp for promotional purposes?*
- Yes
List the name(s) of the individual(s) who have permission to pick up your child from VBS at the end of each day:*
Name
This field is for validation purposes and should be left unchanged.

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