VBS Registration Form

Child's Name (First & Last) *

Parent/Guardian Name (First & Last) *

Address, City, State, Zip Code *

Best Phone Number *

Secondary Phone Number (optional)

E-Mail Address (optional)

Child's Birth Date *

Last Grade Completed in School *

Medical Information (or other pertinent information; PLEASE INCLUDE FOOD ALLERGIES) *

Emergency Contact (Name) *

Phone Number *

Secondary Emergency Contact Name (optional)

Secondary Phone Number (optional)

Dismissal Information (Who may pick up your child at the end of VBS each day?) *

Does your child attend Sunday School? *

If so, where?

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

May we have permission to photograph your child? *

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

Does your child plan to eat dinner with us at 5:30 each night? *

Please leave any additional questions or comments below