VBS 2019!

Register now for VBS 2019!

By filling out this form, you will be submitting registration of your child to our Vacation Bible School, held at First Christian Church of Pleasanton, from 9:30 a.m. until 11:30 a.m., Monday thru Friday, June 10th – 14th, 2019

Last Grade Completed
Child's Birth Date
Your child's current age
Parent or guardian's name
Your home street address
City you live in
Two-letter state designation
Zip code + 4
Parent's Home Phone Number
Your Mobile Phone Number.
Your email address or the email address of someone who can get messages to you.
Someone other than yourself whom we may contact in case of emergency
Contact Number for your emergency contact person.
Does your child have any food allergies or medical concerns? Select your choice and explain in the next field:
Please explain any allergies and/or medical concerns your child may have
Please name your family's Doctor or other medical professional specific to your child's needs
Your chosen family medical practitioner's phone number
Please select the number of this child's siblings that will also be attending. In the paragraph below, please list their names and ages. If "None", select "None"
Please list the names and ages of any other attending siblings, along with their ages, in this space. If "none", leave blank.
You may choose a responsible adult to be able to pick up your child. However, please contact the office at (913)352-8558 if any early or unscheduled pickup becomes necessary.
You may choose a responsible adult to be able to pick up your child. However, please contact the office at (913)352-8558 if any early or unscheduled pickup becomes necessary.
A limited amount of transportation will be available for those who need it. Please select your reply.
Any photographs, filming or recording during VBS will be completely incidental to VBS programming and events, and names will be kept confidential.
You hereby register this child for VBS.
Enter today's date as m/d/y
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