Tar Landing VBS Registration (June 23 - 28, 2019)
Please complete a separate form for each child that will attend.
Child's LAST Name *
Your answer
Child's FIRST Name *
Your answer
Home Phone Number *
Your answer
Parent/Guardian Name(s) *
Your answer
Parent Email(s)
Your answer
Parent Phone Number(s) *
Your answer
Child's Age (at time of VBS) *
Child's Birthdate
MM
/
DD
/
YYYY
Child's last grade completed in school *
Any food allergies or dietary concerns? *
If you marked "yes", please explain.
Your answer
Is there any medical or other information we need to know? *
If you marked "yes", please explain.
Your answer
Emergency Contact Name (other than parent listed above)
Your answer
Emergency Contact Phone Number (other than parent listed above)
Your answer
Who may pick up your child from VBS each day? *
Required
If someone other than parents may pick up child, please list names.
Your answer
If your child is visiting our church, who is he/she a guest of?
Your answer
May we have permission to photograph your child to be included in our Family Night video presentation? (No photographs will be posted online or printed.) *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service