Child's Name (if listing more than one please be specific)

Parent/Guardian's Name

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

Contact Information (Home #)

Contact Information (Work #)

Contact Information (Cell #)

Age information (Child's birthdate)

Age information (last grade the child completed in school)

Parent/Guardian Contact Information (Email address)

Medical Information (Medical or other information we need to know. Please include any food allergies with detailed info for EACH child being registered)

I give my child permission to walk to and from the park with responsible Meadville First Baptist VBS helpers.

Emergency Contacts (other than listed above...names and phone numbers)

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