PHBC’s “Rome: Paul and the Underground Church” VBS

PHBC’s “Rome: Paul and the Underground Church” Vacation Bible School is coming July 12-16 from 6 – 8:30 p.m.

Please complete the form to register your child who has completed Kindergarten through 6th grade.

This form will not work in Facebook, you must open this page in Edge, Chrome, Safari, Firefox or another web browser to complete the form.

(One child per form, please. Refresh this page after clicking submit to register another child.)

All Fields Except Medical / Allergy Information Are Required

Child’s Information

Child’s Name

Gender

Choose one:

Male

Female

Date of Birth

Age

Last Grade Completed

Name of Parent(s)

Parent(s) Information

Street Address

City

State

Zip Code

Home Telephone

Mobile Phone

Parent(s) Email Address

Please enter a personal, not work, email address.

Home Church

Emergency Information

In case of emergency contact …

Relationship of Emergency Contact to Child

Emergency Contact Phone Number

Medical Information

Allergies, Medical Conditions, and/or Special Needs (optional)

If you have completed the form properly, after clicking Submit, you will receive a confirmation email with your child’s information. You can also scroll back to the top of the page and look for a green box that says, “Your child's VBS Registration has been submitted.”

(To register another child, refresh this page after clicking submit.)