Form

Southside Community Church VBS Registration Please complete entire form
Student's Name
Student's Age
Last Grade Completed
Street Address
City
State
Zip Code
Parent's Name
Parent's Phone Number
Parent's Email
Emergency Contact
Emergency Contact Phone Number
Siblings Attending VBS
How did you hear about Southside's VBS?
Do you have a church home?	Yes No
If so, where do you attend?
Allergies or Physical Limitations	Yes No
If Yes, please describe
Additional comments or questions

By clicking on the Submit Form button, you agree to the following statements: 1. In case of a medical emergency, you give your permission to the physician selected by the VBS staff to secure proper treatment and / or hospitalization for your child. 2. You allow Southside Community Church to photograph your child and use these photos on the church Facebook and / or web page.

Southside Community Church VBS Registration