Service Times

  • Sunday Morning 11:00 am
  • Sunday Evening 6:00 pm
  • Wednesday Night 7:00 pm
    • VBS Child Registration


    All fields with a * are required fields.

    Child 1

    *Child Name :

    *Gender :

    *Birthdate :

    *Grade Completed :

    *Address :

    *City :

    *State :

    *Zip :

    *Parents/Guardian :

    *Home Phone :

    *Work Phone :

    *Cell Phone :

    *Email Address :

    *Emergency contact :

    *Relationship to child :

    *Phone :

    *Please place my child with :

    *Name of home church :

    *Food Allergies :

    *Medical Concerns :

    Child 2

    Child Name :

    Gender :

    Birthdate :

    Grade Completed :

    Address :

    City :

    State :

    Zip :

    Parents/Guardian :

    Home Phone :

    Work Phone :

    Cell Phone :

    Email Address :

    Emergency contact :

    Relationship to child :

    Phone :

    Please place my child with :

    Name of home church :

    Food Allergies :

    Medical Concerns :

    Child 3

    Child Name :

    Gender :

    Birthdate :

    Grade Completed :

    Address :

    City :

    State :

    Zip :

    Parents/Guardian :

    Home Phone :

    Work Phone :

    Cell Phone :

    Email Address :

    Emergency contact :

    Relationship to child :

    Phone :

    Please place my child with :

    Name of home church :

    Food Allergies :

    Medical Concerns :

    18059 Leesville Road - Evington, VA - Phone: 434.525.5880 - www.leesvilleroad.net Where Ministry is About Doing Life Together.