Registration Form
Child’s Name____________________________________________ Parent/Guardian Name_____________________________________________________
Address___________________________________________________________________________________________ (street address, city, state, and zip code)
Mailing Address (if different) ____________________________________________________________________________________________________________
Phone Numbers Home  Work  Cell ____________________________________________________________________________________________________

Email ________________________________________________________________________________________________________________________________________

Age Information: 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 

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

Other Information Is your child a member of a church? If so where? 

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

May we have permission to photograph your child?  θ Yes         θ No

May we have permission to use your child’s photograph for the purpose of promotion?  θ Yes        θ No

Registration Form • Administrative Guide CD • VBS 2019