2017 VBS Individual Registration (Ages 4 years through 6th grade)
Please answer all questions as completely as possible. One form per child.
Child's First Name *
Your answer
Child's Last Name *
Your answer
Date of Birth
MM
/
DD
/
YYYY
Age *
School Grade Last Completed *
Parent / Guardian's Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Mailing Address (if different)
Your answer
Best Contact Phone Number (Cell, Home, or Business) *
Your answer
Who's Number Is This? *
Your answer
Email Address
Your answer
Medical Allergy or Other Information We Should Know
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Dismissal Information (Who other than the parent is authorized to pick up your child? *
Your answer
Do you attend church? *
If yes, what church do you attend?
Your answer
Every year, at the end of the week, we make a video of VBS to show family and others at the end of the week program. This video is also often used the Sunday following VBS to share with the congregation what's been going on all week. May we have permission to photograph / video your child and include them in the end of the week video.
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