VBS Registration Printable Registration FormDownload Please enable JavaScript in your browser to complete this form.Child's Name *FirstLastParent/Guardian Name *FirstLastAddress *(Street address, city, state, zip code)Mailing Address (if different)(Street address, city, state, zip code)Home PhoneWork PhoneCell PhoneEmail AddressBirth Date *School Grade *Pre-K1st Grade2nd Grade3rd Grade4th Grade5th Grade(Last grade completed in school)Medical InformationMedical or other information we need to know. (Please include food allergies)Emergency 1 Contact NameRelationshipMotherFatherBrotherSisterAuntUncleGrandmotherGrandfatherOther RelativeFamily FriendPhone NumberEmergency Contact 2 NameRelationshipMotherFatherBrotherSisterAuntUncleGrandmotherGrandfatherOther RelativeFamily FriendPhone NumberEmergency Contact 3 NameRelationshipMotherFatherBrotherSisterAuntUncleGrandmotherGrandfatherOther RelativeFamily FriendPhone NumberDismissal InformationWho may pick up your child at the end of each VBS day?Does your child attend Sunday school?YesNoWhere?Is your child visiting our church?YesNoAs a guest of whom?May we have your permission to photograph your child? *YesNoMay we have permission to use your child's photograph for the purpose of promotion? *YesNoWill your child be riding the bus? *YesNoDrop off address(Street address, city, state, zip code)Submit
