VBS Registration Form

Child's Name

Parent/Guardian Name Name

Street Address

City

State

Zip

Mailing Address

City

State

Zip

Home Phone Number

Work Phone Number

Cell Phone Number

Email address

Age

Birth Date

Last Grade Completed In School

Medical Information or other infomation we need to know. (Please include any food allergies)

Emergency Contacts

(other thean listed above)

Name

Relationship

Phone

Name

Relationship

Phone

Dismissal Information

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

Name

Relationship

Phone

Name

Relationship

Phone

Other Information

Does your child attend Sunday School?

If so, where?

May we have permission to photograph your child?

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