VBS 2021

VBS REGISTRATION FORM

Child First Name*:

Child Last Name*:

Parent/Guardian First Name*:

Parent/Guardian Last Name*:

Address:

Mobile Phone Number*:

Home Phone Number:

Email*:

Age (Birth date for Preschoolers or last grade completed in school)*:
345kindergarten1st2nd3rd4th5th6th
Medical Information (Please include any food allergies):

Emergency Contact Name*:

Emergency Contact Phone Number*:

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

Do you attend church regularly? If so, where?:

If you are visiting, who are your a guest of?:

May we have permission to photograph your child?:
YesNo
May we have permission to use your child's photograph in church publications for the purpose of promotion?:
YesNo