Stellar VBS 2023 @ St Cuthbert

July 24-27 from 9:00am to Noon | Please complete all fields to register your child for our Summer 2023 VBS program. Please submit a separate registration for each child.

Child's Name

*

Birthdate

*

2023-2024 Grade Level

*

Please select one option.

K 1 2 3 4 5

Shirt Size (unisex)

*

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

Does your child have any special dietary or medical needs we should be aware of?

*

Parent Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Emergency Contact 1

*

Emergency Contact 1 Phone

*

Emergency Contact 2

*

Emergency Contact 2 Phone

*

Authorized Pickup 1

Authorized Pickup 2

Authorized Pickup 3

Registration for 1 Child (Includes T-Shirt) $10.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

July 24-27 from 9:00am to Noon

Please complete all fields to register your child for our Summer 2023 VBS program. Please submit a separate registration for each child.

Please Fix the Following

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