Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Child #1 Name *

First Name

Last Name

T-Shirt

XS

Small

Medium

Large

XL

Child #2 Name

First Name

Last Name

T-Shirt

XS

Small

Medium

Large

XL

Child #3 Name

First Name

Last Name

T-Shirt

XS

Small

Medium

Large

XL

Child #4 Name

First Name

Last Name

T-Shirt

XS

Small

Medium

Large

XL

I would like to cover all of the $30/child or some of the cost for my child to attend VBS. Payments of cash, check, or card may be paid during the week of VBS or pay now through the tab at the bottom. *

All

A portion

I am requesting a scholarship to cover the costs. (No additional form necessary.)