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The Rock Bible Institute
2025 Vacation Bible School Registration
DATES: JUNE 23-27
TIME: 9:00 AM - 11:30 AM
OPEN TO AGES 5-12
FREE EVENT!
CHILD INFORMATION
Child's First Name
Child's Last Name
Child's Gender
Male
Female
I'd rather not say
Child's Grade in the Fall
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Child's Date of Birth
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Does child have any allergies?
Yes
No
Please list allergies here
Does child have any medical concerns?
Yes
No
Please list medical concerns here
PARENT OR GUARDIAN INFORMATION
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Relationship to Child
Parent/Guardian Phone Number
Parent/Guardian Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Parent/Guardian Email
In the event that we cannot reach the parent/guardian, please leave information for an emergency contact below.
Emergency Contact First Name
Emergency Contact Last Name
Relationship to Child
Emergency Contact Phone Number
Anything else we should know about?
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