Parent's Name *

First Name

Last Name

Phone *

(###)

###

####

Student's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Have you previously attended VBS?

Yes

No

Do you have a church home? *

Yes

No

Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up) *

Yes

No

Additional Information *

VBS photos/videos are taken for promotional purposes related to Experience Church. These pictures appear in various media outlets such as our Instagram, Facebook, and webpage. Do you allow your child to be included in these photos/videos?

Yes

No

Terms & Conditions *

By checking this box, I agree to the terms and conditions displayed by the Experience Church Student consent form below for the student attending Experience Church's VBS.