Family Life Church, Waukegan, IL

VBS Registration

Monday, July 8 – Friday, July 12, 2024

6:00pm – 8:30pm

Kids Entering Kindergarten through 6th Grades

Contact Form Demo (#3) (#4)

Child's Name

Child's Gender

Child's Birthday

School Grade Completed

Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone

Relationship to Child

Is this Parent/Guardian the Emergency Contact for the child?

Yes

Emergency Contact Name

Emergency Contact Phone

Who Can Pick Up Your Child?

Does the child currently attend a Church?

Not Presently

Family Life Church

Other

What is the Church Name?

Does the child have any Food Allergies or Medical Conerns?

Yes

List Any Food Allergies or Medical Concerns