VBS Child Registration 9 AM - Noon July 9-13, 2018 Ages 3 - completed 5th grade
Please fill out one form per child
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Parent/Guardian First Name *
Parent/Guardian Last Name *
Child First Name *
Child Last Name *
Gender *
Last Grade Completed by 7/1/18 *
Date of Birth (Must be at least 3 by 8/30/18) *
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Address *
City *
State *
ZIP *
Best Phone *
Other Phone
Parent/Guardian email *
Home Church
Allergies or other Medical Conditions *
Emergency Contact
Emergency Contact Phone
Emergency Contact Relationship
Comments
You have my permission and consent for my child to attend VBS, to participate in its activities, to receive emergency treatment if necessary and to allow photographs, videos, and interviews to be taken and published and used to illustrate, promote, and advertise activities at Brunswick Church. I have read and understand these instructions.  Signature Parent or Guardian *
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