Vacation Bible School Registration Form : www.wichitacornerstone.org Wichita KS

Submit 1 Form per Child: *Required Field

Child's Name

Child's Age (Only 5 to 12)

Child's Date of Birth

Parent/Guardian

Address

Parent/Guardian Phone Number

Parent/Guardian Email

Emergency Contact Name

Emergency Contact Phone Number

Allergies or Other Medical Conditions

Emergency Contact Relationship to Child

www.wichitacornerstone.org