VBS Registration

Child's Name

Parent/Gaurdian Name

Address

Mailing Address (if different)

Contact Information

Home Phone

Work Phone

Cell Phone

This address will receive a confirmation email

Age Information

Birth Date

Last Grade Completed In School

Medical Information

Please include any food allergies. If there isn't any important medical information, put NONE.

Medical or other information we need to know.

Emergency Contacts (other than listed above)

Name

Phone

Dismissal Information

Who may pick up your child at the end of each VBS day?

Other Information

Does Your Child Attend Church Anywhere? If so, Where?

If your child is visiting our church, who is he a guest of?

May we have permission to photograph your child?

Yes No

May we have permission to use your child’s photograph for the purpose of promotion?

Yes No

Description

Please fill out this form and click submit.