Registration Form
VBS June 17th - 21st
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
Phone Number
Home
Your answer
Work
Your answer
Cell
Your answer
Email
Your answer
Age Information
Birthday date *
MM
/
DD
/
YYYY
Last Grade completed in school *
Your answer
Emergency Contacts
(other then listed above)
Name & Phone number *
Your answer
Dismissal Information
Who may pick up your child at the end of each VBS day? *
Your answer
Other Information
Does your child attend Sunday School? If so where?
Your answer
If your child is visiting our church, who is she/he a guest of?
Your answer
May we have permission to photograph your child? *
Required
May we have permission to use your child's photograph for the purpose of promotion? *
Required
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