Selma Dothan - VBS Registration

Vacation Bible School Registration

June 5th - 8th
For Ages 3 through 5th Grade
Wednesday - Friday 6:00pm - 8:00pm
Saturday 9:00am - Noon
Family Day to Follow
Director Contact: Amber Love - amber@selmadothan.church

Child's First Name

Child's Last Name

Parent / Guardian Email:

Home Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Home Phone Number:

Alternate Phone Number:

Church Affiliation:

Grade:

Child's Gender:

Child's Birthdate

Child's Age:

Emergency Information

Emergency Contact 1:

Emergency Contact 1 Phone:

Emergency Contact 2:

Emergency Contact 2 Phone:

Allergies

Any other Special Needs:

Dismissal

Who may pick your child up at the end of each VBS Day?

Person #1:

Person #1 Relationship:

Person #2:

Person #2 Relationship:

Parent / Guardian Signature:

Thank you for giving us the opportunity to teach your child(ren) about God and give them the opportunity to have fun while they learn! We look forward to this wonderful week of VBS with your student(s)!

Vacation Bible School Registration

Emergency Information

Dismissal

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Service Times

Contact Info

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