Rooted in Christ VBS Registration
 Participant Form
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Student's Name *
Parent/Guardian's Name *
Address *
E-mail Address *
Home Phone *
Cell Phone *
Work Phone *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Last School Grade Completed *
T-shirt Size *
Home Church
Allergies/Medical Information/Dietary Needs *
Emergency Contact - Name & Phone # *
Emergency Contact - Name & Phone # *
Name(s) of person(s) who may pick child up from VBS: *
If your child has any other special needs, please indicate here: *
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