Full Name
*
Mobile Phone Number
*
Email
*
Street Address
*
City
*
State
*
Zip Code
*
# of Children attending VBS
*
1
2
3
4
5
6
7
8
9
10
Name of all Children Attending VBS
Age of all Children Attending VBS
*
Name(s) of special friend your child might like to be with
Can we post a photo of your child on social media?
*
Is there anything else you would like to share?
In Case Of Emergency Information
In case of emergency contact full name
*
In case of emergency phone number
*
Allergies or other medical conditions of children attending VBS
*
Stay in the loop!
Do you currently attend Pekin First Church of God?
*
Yes
No
If no, do you currently attend another church?
Yes
No
Would you like to receive email updates about any of the below?
SMS Community Event Updates
Email Community Event Updates
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