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Registration Form

Please complete all fields in the form below and click Submit.

Online registration for Vacation Bible School is no longer available. Please sign up on Monday morning at the church. You may print the form available here and bring it with you. VBS 2017 will be held the week of June 26th to 30th for children age 3 through those who are entering 5th Grade in the fall.

 

I'm enrolling my child in:  

Child's First Name:       Child's Last Name:
Age:       Date of Birth (yyyy-mm-dd):       Gender:  
Street Address:  
City:       State:           ZIP Code:  
Home Telephone:     Parent/Caregiver's Cell Phone:  
Home E-mail Address:  
Grade Just Completed (Please type 0 for pre-school students):  Campus:  
Emergency Contact:       Emergency Phone Number:  
Mother's First Name:       Mother's Last Name:  
Father's First Name:       Father's Last Name:  
People allowed to pick up your child:  
Allergies or other medical conditions:  
Home Church:  
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202 North Oklahoma Street ~ Fort Stockton, Texas 79735 ~ Phone: (432) 336-3346 ~ Fax: (432) 336-6717
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