Jerome Prairie Bible Church Building a family of loving disciples

Vacation Bible School Registration Form

VBS 2017 is July 24 - July 28, 9-12 PM

Child's First Name
Child's Last Name
Address 1
Address 2
City
State
Zip
Phone
Entering Grade
Parents/Guardian Name(s)
Email
Do you regularly attend church?
If yes, where?
Person to contact in case of emergency
Emergency Contact Phone
Allergies
How do you hear about us?
Check here if you do NOT want to have your child photographed.
Medical / Surgical Release: I Understand that every effort will be made to contact me if my child needs emergency medical/surgical treatment. But, if it is not practical to do so, I hereby give my permission to the physician selected by the VBS staff to secure proper treatment for my child.
Check here if you DO agree Check here if you DO NOT agree