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VBS Registration Form
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VBS 2019 Registration Form - Into The Wild
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Parent/Guardian Name OR Adult Reg. Name
*
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Home Number
Your answer
Cellphone Number
Your answer
Email
Your answer
AGE
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Grade Your Child Will Be In For Fall 2019-20 School Year
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
Other:
Medical or other information we need to know. (Please include any food allergies.)
Your answer
Emergency Contact Name (If different than listed above)
Your answer
Emergency Contact Phone (If different than listed above)
Your answer
Who may pick up your child at the end of VBS each day? (If different than listed above)
Your answer
If your child is visiting our church, who is he/she a guest of?
Your answer
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
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