Register

Child's First Name:
Child's Last Name:
Date of Birth:
Grade Completed:
Age:
Parent's First Name:
Parent's Last Name:
Address:
City:
State:
zip:
Home Phone:
Cell Phone:
E-mail:
Emergency First Name:
Emergency Last Name:
Emergency Phone:
Is there a special friend your child would like to be with?
Special Needs / Allergies:
Person Responsible for Pickup after VBS:
Their phone number:
Relationship to child:
What is your home church?
Has your child attended VBS at Immanuel before?
Would you like to order a CD of this year's VBS music for $3?
Please place your fees in the mailbox outside of the church office. $10 for one child, $20 for two, $25 max/family.