VBS Registration

2011 VBS REGISTRATION FORM

Child’s Name *

First

Last

Parent/Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Home Phone # *

Work Phone # *

Cell Phone # *

Child's Age *

Medical information we need to know (please include any food allergies) *

Emergency Contact (name and number) *

Emergency Contact #2 (name and number) *

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

Do you attend Sunday School? If so where? *

If you are visiting our church, who are you a guest of? *

May we photograph your child for the purpose of a VBS picture presentation at the luncheon on Friday, July 29? *

Yes No