VBS Registration

CLICK HERE for detailed information on VBS.

You may register more than one child (up to four) on this page. If you have questions about registration, please contact Joe Hacker (children@choctawumc.com or 405.390.8151).

* indicates required field

Email:*

Child #1 Name:*

Child #1 Age:*

Child #1 Grade Upcoming School Year:*

Child #1 Medications, Allergies, Limitations:*

Child #2 Name (if applicable):

Child #2 Age (if applicable):

Child #2 Grade Upcoming School Year (if applicable):

Child #2 Medications, Allergies, Limitations (if applicable):

Child #3 Name (if applicable):

Child #3 Age (if applicable):

Child #3 Grade Upcoming School Year (if applicable):

Child #3 Medications, Allergies, Limitations (if applicable):

Child #4 Name (if applicable):

Child #4 Age (if applicable):

Child #4 Grade Upcoming School Year (if applicable):

Child #4 Medications, Allergies, Limitations (if applicable):

Parent/Guardian Name(s):*

Home Address (include street, city, state, ZIP):*

Who is authorized to pick the child/children up from VBS? LIST NAMES AND PHONE NUMBERS:*

Emergency Contact (other than parent if not listed above). LIST NAME AND PHONE NUMBER:

How did you learn about this VBS? Check all that apply:*

Church News
Banner
Facebook
Friend
Other

Photo Release: Do we have permission to use your child's photo on our social media?*

Yes
No

CAPTCHA Code:*