Youth VBS Registration

You may register children/teenager who have COMPLETED Pre-Kindergarten through High School for the program. (One registration form per child.) You will receive a confirmation email once you have successfully registered. All registration will be completed online either now or on-site at The HOB Campus with Sis. Rose Ransom .

If you or your child would like to participate in this event as a participant, please complete the following form. If you are under 18, please have your parent or guardian complete the form. Thanks for your understanding.

* Required Fields

*Child's Name:
*Child's Birthday (mm/dd/yyy):
Gender:
*Current Grade Level:
*Address:
*City:
*State:
*Zip:
*Parent/Guardian Name:
*Home Phone or Cell Phone:
Email:
Email Permission:
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
Emergency Contact Name (2):
Emergency Contact Phone (2):
*Allergies / Special Needs:	YES NO
Allergies, Medical, & Special Needs: (Leave Blank if None):
*Authentication:

Please click the Send button only once.