Register for VBS Online today!Note: Blanks with ** are required.

Child's Name: **							Email Address (if available):
Grade Entering:**							Birthday:**
Parents Name:**							Parent's Address:**
Parent's Phone:**							Parent's Alt Phone :
Home Church (if not Redeemer):							Location:
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Emergency (Secondary) Contact :**							Relationship to Student:
Emergency Contact's Phone:**							Emerg. Contact's Alt Phone:
Do you need Transportation?			Yes		No
Address for Pickup:
Food Allergies, Medical Problems or Special Needs: If None indicate "None" **
T-SHIRT SIZE: **
YOUTH:	Small	Medium		Large		XL
ADULT:	Small	Medium		Large		XL