VBS Registration
Child's Name
*
First Name
Last Name
Age
Birthdate
*
MM
DD
YYYY
Last Grade Completed
*
Parent's Name
*
First Name
Last Name
Parent's Name
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
(###)
###
####
Parent's Cell Phone
(###)
###
####
Parent's Cell Phone
(###)
###
####
Email
Medical
Please list anything we need to know. (Please include food allergies and special needs)
Emergency Contact
*
Other than listed above
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Who can pick up your child at the end of the VBS day?
*
Is there anything else we should know?
If your child is visiting out church - who is he/she a guest of?
May we have permission to photograph your child?
*
Yes
No
May we have permission to use your child's photograph for the purpose of promotion?
*
Yes
No
Thank you!
