Kingdom Life Church AK - VBS REGISTRATION

ILLUMINATION STATION VBS REGISTRATION

Child's First Name

Child's Last Name

Birthdate

Gender

Last school grade completed

Allergies - If none, please enter NONE

Anything else you would like to share?

Parent/ Guardian First Name

Parent/Guardian Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Emergency Contact First Name

Emergency Contact Last Name

Phone Number

Consent

Signature

Would you like to receive information about next year’s VBS?

YES

NO

Please notify me by:

TEXT

EMAIL

MAIL