VBS Registration 2024

June 17-21 from 9am to Noon | VBS is open to all children age 3 (must be potty trained) through 5th grade. VBS begins each day at 9am and concludes at noon. Please click submit when you've completed the form.

Parent/Guardian Information

Name

This address will receive a confirmation email

Phone

Address

Who will pick up your child at the end of each VBS day?

Are you currently attending a church?

Please select one option.

Yes No

Child's Information

Child's Full Name

Child's Date of Birth mm/dd/yyyy

Last grade completed in school:

Please select one option.

3 Years Old 4 Years Old Pre-K Kindergarten 1st 2nd 3rd 4th 5th

Medical and/or other important information concerning your child. (Please include food allergies):

2nd Child's Full Name

Child's Date of Birth mm/dd/yyyy

Last grade completed in school:

Please select one option.

3 Years Old 4 Years Old Pre-K Kindergarten 1st 2nd 3rd 4th 5th

Medical and/or other important information concerning your child. (Please include food allergies):

Emergency Contact

Full Name

Phone

Full Name

Phone

By submitting this form you agree to give Lycoming Centre permission to photograph your child and use their photo for promotional purposes.

Please click

Please select all that apply.

I agree

Description

June 17-21 from 9am to Noon

VBS is open to all children age 3 (must be potty trained) through 5th grade. VBS begins each day at 9am and concludes at noon. Please click submit when you've completed the form.

VBS Registration 2024

Description

Please Fix the Following