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Vacation Bible School Registration
Please register each child individually
Child's Name *
Your answer
Child's Gender *
Child's Address *
Your answer
Child's Home Telephone
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Child's Age *
Your answer
Child's T-shirt Size
Your answer
Mother's Name *
Your answer
Mother's Phone Number *
Your answer
Mother's Address (if different from child)
Your answer
Father's Name *
Your answer
Father's Phone Number *
Your answer
Father's Address (if different from child)
Your answer
In case of Emergency contact (name) *
Your answer
Emergency contact (cell number)
Your answer
Emergency contact (home number)
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Other Guardian/Relative or Friend Name
Your answer
Other Guardian/Relative or Friend Phone Number
Your answer
May we put your child's pictures on the Church Website and/or Facebook page *
Please list any allergies or other conditions which may limit activity *
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Any other special instructions or things you would like us to know about your child?
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