REGISTER FOR SCUBA VBS TODAY!

Child Information:

First Name:

Last Name:

Gender:
Male
Female

Age:

Grade Completed '23-'24:

Name of parent(s) or guardian(s):

Address 1:

Address 2:

County:

City:

State:

Zip/Postal Code:

Phone Number:

Email Address:

Name of home church:

Please list any allergies, medical conditions or special needs:

Names of people who can pick this child up:

Name:

Phone Number:

Relationship:

Photo Concent:
I release Cornerstone to use photos of my child at VBS in promotional material on our church website, app and social media platforms.