Registration Form

We are so excited to have your child attend our Vacation Bible School!

Child’s Name________________________________________________________

Parent/Guardian Name________________________________________________

Address____________________________________________________________

                                      (Street address, city, state, and zip code)

Mailing Address (If Different)___________________________________________

Phone Numbers

Home______________________________________________________________

Work_______________________________________________________________

Cell________________________________________________________________

Email_______________________________________________________________

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 (Other than listed above.)

Name___________________________ Phone Number ______________________

Name___________________________ Phone Number ______________________

Dismissal Information

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

___________________________________________________________________

Other Information

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? Yes_______ No ____________

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

Yes _______ No _______