Vacation Bible School at University Presbyterian Church
Please complete the following form to register your child
Email address *
Child's Name *
Your answer
Parent/Gardian Name *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone Number *
Your answer
Mobile/Alternative Phone Number *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Sex *
Last School Grade Completed *
Name/s of siblings also being registered?
Your answer
Emergency Contact
In case of an emergency (if parent/guardian cannot be reached), please contact:
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact's Relationship to Child *
Your answer
lease list any allergies/medication/medical needs that VBS staff should be aware *
Your answer
Person/s allowed to pick up this child at the end of each VBS day (if this is left blank, the only person that will be allowed to pick up your child will be the Parent/Guardian listed at the top of this form)
Your answer
Phone Number/s of Person/s allowed to pick up your child
Your answer
Other information that you would like us to know about your child
Your answer
Any special needs or circumstances we should be made aware of about your child?
Your answer
This will be my child's first VBS experience.
Would you like to volunteer to help with VBS?
I understand that my child may be photographed as a part of documenting for future VBS events and these photographs may be used for future advertisement use. We will do our best to not photograph close-up faces. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of University Presbyterian Church of El Paso. Report Abuse - Terms of Service