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VBS Registration Form
June 5th-8th
6:00-8:00pm
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June 5th-8th!
Child's Name (First & Last)
*
Your answer
Name Child Prefers
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Child’s Grade for 2022-2023 School Year
*
Pre-K
K
1st
2nd
3rd
4th
5th
6th
Parent’s Name
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Your answer
Address
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Your answer
City
*
Your answer
Zip
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
Child Care Provider’s Name & Phone Number
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Your answer
Please list the name(s) and phone number(s) of anyone besides you who is allowed to pick up your child.
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Your answer
Does your child have any allergies or diet restrictions? Please list allergy AND severity (Ex. Life threatening, moderate, mild, etc.).
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Your answer
Does your child have an EpiPen?
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Yes
No
Do we have your consent to take/post pictures of your child on social media?
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Yes
No
Is there any other important information you need to share with us?
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Your answer
Would you like more information about our church?
*
Yes
No
If yes, by which method?
Email
Mail
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