VBS Registration Form
Ages 3 through Completed 5th grades
July 16-18
9am-12noon


at Westminster Presbyterian Church
1715 Broad River Road
Columbia, SC 29210

Student's Name *
Your answer
Parent/Family/Guardian Name *
Your answer
Address *
Your answer
Email Address
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Work Phone *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Last School Grade completed *
If toddler, just fill in "toddler"
Your answer
Friends of your child at Westminster Presbyterian Church?
Your answer
Allergies/Medical Information/Other *
(if none, simple write "None")
Your answer
Emergency Contacts (provide name + number) *
Your answer
Dismissal Information *
Name(s) of person(s) who may pick up this child from VBS
Your answer
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