VBS

Child Registration

Child's Name*
Parent/Guardian Name*
Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address (If different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Work Phone*
Cell Phone*
Email*
Birth Date*
Last grade completed in school*
Medical Information
Medical or other information we need to know. (Please include any food allergies.)
Emergency Contacts (other than listed above)
Names & Phone numbers (Press the plus to add an additional line)
Name Phone Number
Dismissal Information
Who may pick up your child at the end of each VBS day? (Press the plus to add an additional line)
Does your child attend Sunday School? If so where?
If your child is visiting our church, who is he 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

Name*
Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address (If different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Work Phone*
Cell Phone*
Email*
Does you attend Sunday School? If so where?
If you are visiting our church, who are you a guest of?
May we have permission to photograph you?*
- Yes
- No
May we have permission to use your photograph for the purpose of promotion?*
- Yes
- No

Name	Phone Number