VBS Registration - Bascom Community Church

Please enable JavaScript in your browser to complete this form.

Child's Name

First

Last

Child's Age

Last School Grade Completed

Child's Gender

Parent/Guardian Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Name of Parent(s)/Guardian (s)

First

Last

Emergency Contact Person / Relationship to Child

Emergency Phone

Allergies / Medications

Home Church

Would you like to purchase a CD of the VBS Songs for $7?