VBS REGISTRATION FORM
Wayside VBS July 15-19, 2018
Child's Name *
Your answer
Parent/Guardian Name *
Your answer
Address(street address, city, state, and zip code) *
Your answer
Mailing Address (if different)
Your answer
Mailing Address (if different)
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
Grade entering in the fall *
Medical or other information we need to know. (please include any food allergies)
Your answer
Emergency Contacts (other than listed above) Name and phone numbers
Your answer
Who may pick up your child at the end of VBS each night? *
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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