VBS 2022

LICF VBS - July 18th - 20th from 6pm until 8pm

* Indicates required field

Name of Child attending *

Birthdate *

Gender *

Male Female

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Name *

First

Last

Email *

Home/Cell Phone *

Work Number *

In case of emergency *

First

Last

Relationship to Child *

Emergency Phone Number *

Who can pick up your child? *

Medical concerns *

Food allergies *

Comment *

Last school grade completed *

Name of home church *

Submit