VBS Registration

VBS Registration Form

Child's Name:

Parent/Guardian Name:

Street Address:

City: State: Zip Code:

Mailing Address (if different):

Mailing City: Mailing State: Mailing Zip:

Phone Numbers

Home:
Work:

Cell:

E-mail:

Age Information
Birth Date: Last Grade Completed in School:

Medical Information

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

Emergency Contacts
Name: Phone:

Name: Phone:

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

Other Information
Do you attend Sunday School? If so, where?

If you are visiting our church, of whom are you a guest?
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