NorthRidge Humboldt VBS 2019
Please fill out one per child eligible to attend.
Child's Last Name *
Your answer
Child's First Name *
Your answer
Grade Entering in Fall *
Parent/Caretaker Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
May we send text messages to this number in the case of an emergency?
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
List the name(s) of anyone else that may pick up your child.
Your answer
I give permission for photos of my child to be used by NorthRidge Church
Special Concerns?
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