St. Matthew Church
Please fill out the following to register your child for our annual Vacation Bible School.

NOTE: A separate registration is required for each child.

Please read the PHOTO WAIVER and the LIABILITY RELEASE statements.

CHILD'S FIRST NAME
Your answer
CHILD'S LAST NAME
Your answer
CHILD'S NICKNAME
Note: If not applicable, type NONE.
Your answer
CHILD'S BIRTHDATE
MM
/
DD
/
YYYY
GRADE CHILD COMPLETED IN JUNE OF THIS YEAR
Your answer
CHILD'S T-SHIRT SIZE
Your answer
ALLERGIES/MEDICATIONS/CONDITIONS
Note: If not applicable, type NONE.
Your answer
PARENT'S FIRST NAME
Your answer
PARENT'S LAST NAME
Your answer
STREET ADDRESS
Your answer
CITY
Your answer
STATE
Your answer
ZIP CODE
Your answer
HOME PHONE
Your answer
WORK PHONE
Your answer
CELL PHONE
Your answer
E-MAIL ADDRESS
Your answer
EMERGENCY CONTACT NAME
Your answer
EMERGENCY CONTACT PHONE NUMBER
Your answer
PERSONS ALLOWED TO PICK UP YOUR CHILD
Note: If not applicable, type NONE.
Your answer
NAME OF YOUR CHURCH
Your answer
HOW DID YOU HEAR ABOUT OUR VBS PROGRAM?
Your answer
I HAVE READ AND AGREE TO THE TERMS OF THE PHOTO WAIVER STATEMENT.
Note: Please find a link to the statement at the top of this page.
Required
I HAVE READ AND AGREE TO THE TERMS OF THE LIABILITY RELEASE STATEMENT.
Note: Please find a link to the statement at the top of this page.
Required
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