Gadgets and Gizmos • VBS 2017
Student's First Name
Your answer
Student's Last Name
Your answer
Birthdate
Children must turn 4 before the start of VBS
MM
/
DD
/
YYYY
Boy or Girl?
Allergies/Special Medical Concerns
Food/Drug Allergies, Epilepsy, or Other Special Concerns
Your answer
School this Fall
Your answer
Grade in Fall
Home Church
Your answer
Parent/Legal Guardian's First Name
Your answer
Parent/Legal Guardian's Last Name
Your answer
Primary Phone Number
The number where you will be most easily reached during the event.
Your answer
Secondary Phone Number
Your answer
Email Address
Your answer
Name of Emergency Contact during the event
Other than parent/guardian
Your answer
Phone Number of Emergency Contact during the event
Your answer
How did you hear about VBS?
Please check all that apply.
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