VBS 2019 Registration Form
Lauderhill Seventh-day Adventist Church

Monday, June 24 – Friday, June 29
8:00 am – 2:00 pm
For ages 4–14
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Child's Name (One form per child) *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
Grade Entering
Parent/Guardian Name(s) *
Child's Address - Line 1
Child's Address - City
Child's Address - State
Child's Address - Zip
Contact Phone Number (include area code) *
Secondary Phone Number *
Contact Email Address *
Emergency Contact Name *
Emergency Contact Phone Number *
Name of person picking up child *
How will your child go home (car, bus, walk, etc.)?
Please list all allergies and/or medical concerns:
How did you hear about VBS?
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