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VBS Registration Form
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* Indicates required question
Child's First and Last Name
*
Your answer
Parent/Guardian Name
*
Your answer
Address
*
Your answer
Mailing Address (if different)
Your answer
Contact Information: best phone number to reach you
*
Your answer
Contact information: email address
Your answer
Child's birth date
*
MM
/
DD
/
YYYY
Last grade completed in school
Your answer
Medical information we need to know: (Please include any allergies)
Your answer
Emergency Contacts (other than already listed): Please include name and number
*
Your answer
Dismissal information: Who may pick up your child at the end of each VBS day?
*
Your answer
Does your child attend a church? If so, where?
Your answer
May we have permission to photograph your child?
*
Yes
No
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