Online Registration

PLEASE NOTE: The Preschool groups are FULL for both weeks. The K-1st grade group is full for July 12th to 16th, 2010.

* Indicates REQUIRED field. Please note children can only be registered for one week of VBS, unless the parent is a volunteer for both weeks.

1. Did you attend last year? Please Select Yes No
2. How did you hear about us? Please Select Email Friend Banner/Sign Church Bulletin Flyer Newspaper Other
3. Dates Attending? Please Select July 12th to 16th, 2010 July 19th to 23rd, 2010
4. * Date of Birth
5. * First Name
6. * Last Name
7. * Street Address
8. * City
9. * State
10. * Zip
11. * Home Phone
12. * Email Address
13. * Please Re-Enter Email Address
14. Parent 1 Name
15. Parent 1 Phone
16. Parent 2 Name
17. Parent 2 Phone
18. Emergency Contact Name
19. Emergency Contact Phone
20. Allergies or Medical Conditions?
21. T-Shirt Size Youth - X-Small Youth - Medium Youth - Small Youth - Medium Youth - Large Youth - XL Adult - Small Adult - Meduim Adult - Large Adult - XL Adult - XXL
22. Doctor Name
23. Doctor Phone
24. * Last Grade Completed Select One Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade
25. * Home Church Select One Christ's Church of Fountain Hills Church of Jesus Christ - LDS Church of The Ascension Faith Mountain Church First Baptist Church of Fountain Hills Fountain Hills Christian Center Fountain Hills Presbyterian Church Four Peaks Community Church Joy Christian Community Church McDowell Mountain Community Church Scottsdale Bible or North Chapel Shepherd of the Hills St. Anthony on the Desert The Anglican Church of the Atonement The Fountains - UMC Trinity Luthern Church Other None
26. Additional Information we should know?