VBS Registration Form 2018
For the Safety of your child, please be sure this form is completed prior to leaving your child at VBS.
Email address *
Student's Name *
Your answer
Parent/Family/Guardian Name *
Your answer
Address *
Your answer
E-mail Address
Your answer
Phone Numbers (Home, Cell, Work) *
Your answer
Date of Birth
MM
/
DD
/
YYYY
Last school grade completed
Your answer
Home Church
Your answer
Friends of your child at this church
Your answer
Allergies/Medical Information/Other
Your answer
Emergency Contact 1 (Name and number) *
Your answer
Emergency Contact 2 (Name and number)
Your answer
Dismissal Information - Name(s) of person(s) who may pick up this child from VBS *
Your answer
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