VBS Registration Form

The special needs form is not required. It is simply to convey concerns that we should be aware of. You only need to fill out the questions that pertain to your child.
Student Information
Student's Name *
Student's Name
Date of Birth *
Date of Birth
Second Student's Name
Second Student's Name
Optional
Date of Birth
Date of Birth
Third Student's Name
Third Student's Name
Optional
Date of Birth
Date of Birth
Fourth Student's Name
Fourth Student's Name
Optional
Date of Birth
Date of Birth
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Name
Phone Number *
Phone Number
Emergency Contact Information
Emergency Contact *
Emergency Contact
At least one emergency contact is required
Emergency Contact's Phone Number *
Emergency Contact's Phone Number
Second Emergency Contact
Second Emergency Contact
optional
Second Emergency Contact's Number
Second Emergency Contact's Number

Traditional service at 9AM || Praise Service at 10:30
Sunday School for all ages - 10:30AM
Phone Number: 970-242-0577 | Fax Number: 970-241-6919
Email Address: cumchurch1007@msn.com

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