LifeHouse VBS Registration
Register for our "CONCRETE & CRANES" VACATION BIBLE SCHOOL (VBS) JULY 11-14, 6:00-8:00 pm at FARIES- 29 S. MAIN ST. SMYRNA, DE 19977. For ages 4 years old to 5th Grade.
Parent/Guardian Name: *
Phone Number: *
Address: *
Email: *
Medical Information
Medical or other information we need to know. Please include any food allergies and name of child next to it. If your child has severe food allergies we ask that you bring their snack each day. Also, for safety reason we request children DO NOT wear FLIP FLOPS!
Medical Information *
Emergency Contact (Other than listed above) & Approved to Pick-Up Child *
Phone Number *
Does your child attend Sunday School or Church *
Children's Information
Please fill out the information below for each child.
Child's Name (1) *
Birth Date (1) *
MM
/
DD
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YYYY
Age or Grade you Just Finished (1) *
Gender (1) *
T-Shirt Size (1) *
Second Child
Please fill out the information below for your second child.
Child's Name (2)
Birthdate (2)
MM
/
DD
/
YYYY
Age or Grade you Just Finished (2)
Clear selection
Gender (2)
Clear selection
T-Shirt Size (2)
Clear selection
Third Child
Please fill out the information below for your third child.
Child's Name (3)
Birthdate (3)
MM
/
DD
/
YYYY
Age or Grade you Just Finished (3)
Clear selection
Gender (3)
Clear selection
T-Shirt Size (3)
Clear selection
Fourth Child
Please fill out the information below for your fourth child.
Child's Name (4)
Birthdate (4)
MM
/
DD
/
YYYY
Age or Grade you Just Finished (4)
Clear selection
Gender (4)
Clear selection
T-Shirt Size (4)
Clear selection
Fifth Child
Please fill out the information below for your fifth child.
Child's Name (5)
Birthdate (5)
MM
/
DD
/
YYYY
Age or Grade you Just Finished (5)
Clear selection
Gender (5)
Clear selection
T-Shirt Size (5)
Clear selection
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