Request a VBS Summer Team Church/Organization* Address of the Church (where VBS will be held) Street Address City State / Province / Region ZIP / Postal Code Contact Person* First Last Preferred Email* Preferred PhoneAre you interested in pairing up with another church for a double week? Yes No Have you confirmed doing a double week with the church? Yes No If a double week is confirmed with both churches, only one request form is needed. Please coordinate with the other church for which weeks would best work for both prior to submitting this form. NOTE: Both churches will be required to provide a Host Church Info Form once confirmed.Please enter the name of the church you are pairing up with. Request Dates for VBS ProgramPlease select your top 3 week choices from the below boxes. If you are hosting a camp, please pick the best fitting week and list the specific dates of your camp (including requested arrive/departure dates) in the comment box.Please indicate if you are flexible for any week. We are flexible for any week. We are not flexible. The First Choice listed is a confirmed date that cannot be changed. First ChoiceWeek 1 - June 3-10Week 2 - June 10-17Week 3 - June 17-24Week 4 - June 24-July 1Week 5 - July 1-8Week 6 - July 8-15Week 7 - July 15-22Week 8 - July 22-29Week 9 - July 29-August 4Second ChoiceNo preferenceWeek 1 - June 3-10Week 2 - June 10-17Week 3 - June 17-24Week 4 - June 24-July 1Week 5 - July 1-8Week 6 - July 8-15Week 7 - July 15-22Week 8 - July 22-29Week 9 - July 29-August 4Third ChoiceNo preferenceWeek 1 - June 3-10Week 2 - June 10-17Week 3 - June 17-24Week 4 - June 24-July 1Week 5 - July 1-8Week 6 - July 8-15Week 7 - July 15-22Week 8 - July 22-29Week 9 - July 29-August 4Comments about request dates: Do you have a specific student you would like to request for your VBS/camp?