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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