Street Address, City, State, Zip Code

If different from above

Phone Number

Phone Number

Phone Number

Birthdate

Last Grade Completed

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

Name and phone number (other than above)

Who may pick up your child at the end of each VBS day?

Does your child attend church? If so, where?

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