Registration Form
Please fill out one form for each child.
Child's First Name *
Your answer
Child's Last Name *
Your answer
Parent/Guardian's Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Mailing Address (if different)
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Work Phone Number
Your answer
Email Address *
Your answer
Birth Date *
MM
/
DD
/
YYYY
School Grade Last Completed *
Medical Information, including allergies *
Your answer
Emergency Contact Name (other than parent/guardian) *
Your answer
Emergency Contact Number *
Your answer
Who may pick up your child at the end of each VBS day? *
Your answer
Does your child attend Sunday School? *
If yes, where?
Your answer
If your child is visiting our church, whose guest is (s)he?
Your answer
May we have permission to photograph your child? *
May we have permission to use your child's photograph for the purpose of promotion? *
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