Online Registration Form

Parent / Guardian Information
Primary Parent Contact Name*
First Last
Primary Email*
Secondary Email
Primary Daytime Phone*
Phone Type*
- EVBS is allowed to send me text messages.
Secondary Phone
Secondary Phone Type
- EVBS is allowed to send me text messages.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Church Affiliation*
Child Registration
Register Students
Child Name Actions
There are no Children.
Maximum number of children reached.
Emergency Contact Information
Emergency Contact Name*
First Last
Emergency Contact Relationship
Emergency Contact Phone*
Physician Name*
Physician Phone*
Registration Fee
Consent*
By checking the box below you are giving permission for your child(ren) to participate in Pleasantville's Ecumenical Vacation Bible School (EVBS) and you understand and accept all risks to participating in the planned activities.

Pleasantville EVBS may take pictures or videos of your child during the course of the program. These photos will be shared in the Thursday evening program and may be used for promotional purposes in the future.
I agree
Hidden
Number of Kids
Registration Fee
Price: $35.00
Registration Fee
Price: $35.00
Registration Fee
Price: $35.00
Hidden
Registration Cost
Hidden
Registration Cost
Hidden
Registration Cost

Child Name	Actions

There are no Children.

Credit Card

Cardholder Name

Card Details

We need volunteers!
- I can volunteer the whole week
- I can volunteer Monday morning
- I can volunteer Thursday evening
Adult and high school volunteers are needed to teach, supervise, run outdoor games, prepare daily snacks, set-up, clean-up and more.
Comments
This field is for validation purposes and should be left unchanged.

Parent / Guardian Information