VBS Registration

VBS 2021

Wednesday Nights

June 9th

June 16th

June 23rd

June 30th

6:30 p.m. - 8:00 p.m.

Online registration

For Elementary-aged kids (just finished K-6th Grades)

Find us at:

2820 N Pleasant View Prescott Valley, AZ 86314

Phone:

928-772-7218

Email us at:


Child's First & Last Name
Gender
Age
Date of Birth
Grade Completed (K-6)
Parent/Guardian's First & Last Name
Street Address
City & Zip Code
Mailing Address
Home Phone Number
Cell Phone Number
Email Address
Medical Information-List by name of child. Please include any food or animal allergies.
Emergency Contacts-Must have 2
Dismissal Information-Who may pick up your child (children)?
Do you attend church?
If yes, where?
Will you allow us to use your child's/children's pictures and names on our church website?