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Register for VBS

at Central Assembly of God

Vero Beach, FL

Mon Jun 14–Fri Jun 18 AT 9 a.m.–noon

Family Information

Address

Street

Street 2

City

State/Province

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Email

Primary Phone

Alternate Phone

Emergency Contact

Relationship to Student

Phone Number

Student Information

First Name

Last Name

Gender

Male

Female

Birth Date Make sure to select correct year before selecting the birth month/day.

Age Group

4 Years Old

5 Years Old

6 Years Old

7 Years Old

8 Years Old

9 Years Old

10 Years Old

11 Years Old

Food Allergies

Details

Medical Concerns

Details

Shirt Size

Youth XSmall

Youth Small

Youth Medium

Youth Large

Youth XL

Adult Small

Adult Medium

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