Please fill out one form per child.
Your Name (required)
Your Email (required)
Child's Name (required)
Gender of Child (required)
Grade Just Completed (required)
Date of Birth (required)
Doctors Name / Policy Number (required)
Person(s) Picking Up Child Each Day (required)
Phone Number (required)
Do You Attend North Hills Church?
(Optional) Other church affiliation?
How would you like to pay? ($25 per child)
Pay Online (by credit card)@ VBS Table in LobbyMail to NHC
(Optional) CREDIT CARD
(Optional) Type of Card
(Optional) Card Number
(Optional) Expiration Date
(Optional) CVV (security code)
I authorize the posting of photographs, video and/or likeness of my child on NHC website and social media outlets (Ex: Facebook).
I understand my child's name will not be published anywhere.
I Give Permission.