2017 VBS Registration Form
(one per child)
July 24-28. 9 am-noon
Child's Name *
Your answer
Child's Age *
Date of Birth *
MM
/
DD
/
YYYY
Raising Grade Level *
Name of parent(s) *
Your answer
Street Address *
Your answer
City *
Your answer
Zip *
Your answer
Home Phone
Your answer
Cell Phone(s)
Your answer
Home Email Address *
Your answer
Home Church
Your answer
Allergies or other medial conditions
Your answer
ICE *
In Case of Emergency Contact Person
Your answer
ICE *
Phone
Your answer
ICE *
Relationship to Child
Your answer
Name of friend(s) your child would like to be with at VBS
First and last name separated by commas
Your answer
Other Adults authorized to pick up your child
Only parents and/or anyone mentioned here will be allowed to pick up your child
Your answer
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