VBS Registration

Child's Name *

First

Last

Parent/Guardian Name *

First

Last

Address *

(Street address, city, state, zip code)

Mailing Address (if different)

(Street address, city, state, zip code)

Home Phone

Work Phone

Cell Phone

Email Address

Birth Date *

School Grade *

(Last grade completed in school)

Medical Information

Medical or other information we need to know. (Please include food allergies)

Emergency 1 Contact Name

Relationship

Phone Number

Emergency Contact 2 Name

Relationship

Phone Number

Emergency Contact 3 Name

Relationship

Phone Number

Dismissal Information

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

Does your child attend Sunday school?

Where?

Is your child visiting our church?

As a guest of whom?

May we have your permission to photograph your child? *

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