Scuba VBS Registration

July 7 - 10 | We're so glad your kids are going to dive in and have fun with us at Scuba VBS this summer!
Scuba VBS Planning Team

Name

*

Gender

*

Please select one option.

Male Female

Birthdate (XX/XX/XXXX)

*

Grade entering Fall 2024

*

Please select one option.

Pre-Kindergarten Kindergarten 1st 2nd 3rd 4th 5th 6th

Parent/Caregiver Name

*

Address

*

Home Phone

Mobile Phone

*

Email

This address will receive a confirmation email

Home Church (if not Koerner Heights)

Emergency Contact Name

*

Emergency Contact Phone

*

Allergies or Other Concerns

Name of friend your child might like to be with

We would like to come for the family evening meal before VBS

Please select all that apply.

Yes No

Number that will join us for the meal

Description

July 7 - 10

We're so glad your kids are going to dive in and have fun with us at Scuba VBS this summer!
Scuba VBS Planning Team

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