VBS Registration

Menu

Childs Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Mailing Address (if different from above)

Home Phone

Work Phone

Cell Phone *

Email Address *

Date of Birth *

Last Grade Completed *

Medical or other information we need to know. (Please include any food allergies) *

Emergency Contact (other than listed above) Name and phone number. *

Dismissal Information. Who may pick up your child at the end of each VBS day? *

Other Information. Does your child attend church? If so, where?

If your child is visiting our church, who is he a guest of?

May we have permission to photograph your child?

YesNo

May we have permission to use your child's photograph for the purpose of promotion?

YesNo