Child's Name (required)
Street Address (required)
Postal Code (required)
Birth Date (required)
Going to Grade (required)
Care Card Number (required)
Parent's Name (required)
Parent's E-mail (required)
Parent's Phone Number (required)
Emergency Contact Name (in case we can't reach you) (required)
Emergency Contact Phone Number (required)
Relationship of Emergency Contact to You (required)
Anything else we need to know?
How did you hear about us? (required)
Attending Langley Canadian Reformed ChurchPreviously attended VBSFacebookReceived a flyerReceived a postcard in the mailSign on the road
Do you have a Bible at home? (required)
Name of your home church, if any
May we use pictures of your child(ren) for informational or promotional purposes?
Yes, I give consentNo, I do not give consent
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21804 52 Avenue, Langley, BC Phone: (604) 530 7612
Sunday @ 9:30 AM & 2:00 PM
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