St. John's VBS 2018 Child Registration Form
Welcome to the VBS Child Registration form!

If you have any questions please contact St. John's church office at (920) 261-5959.

Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender
Child's Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Last School Grade Completed *
Your answer
Name of Parent(s) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Phone Number *
Your answer
Phone Type
Email Address *
Your answer
Home Church
Your answer
Days Present *
Required
T-shirt Size *
Person Responsible for pick up after VBS
Your answer
Their Phone Number
Your answer
Relationship to the child
Your answer
In case of emergency contact name *
Your answer
Phone Number *
Your answer
Relationship to Child *
Your answer
Allergies or other medical conditions (If yes please provide the medical direction provided by a medical physician to administer emergency care) *
I authorize and empower the VBS staff to consent to and authorize any medical care or treatment for the minor that may appear reasonably necessary as a result of emergency, accident or illness of the minor whether occurring before, during or after the event. *
I grant permission to all of the foregoing to use any photographs, motion pictures, recording or any other record of this for any legitimate purpose. *
How did you hear about our VBS?
Your answer
Would you like more information about St. John's church
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