JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
LIAC VBS REGISTRATION FORM
PLEASE COMPLETE ONE FORM FOR EACH CHILD YOU ARE REGISTERING!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
Parent / Guardian Name
*
Your answer
Home Address
*
Your answer
Mailing Address (if different)
Your answer
Home Phone:
*
Your answer
Parent / Guardian Cell Phone:
*
Your answer
Parent / Guardian Cell Phone:
Your answer
Work Phone:
Your answer
Parent / Guardian Email Address:
*
Your answer
Child's Date of Birth:
*
Your answer
Last grade completed in school
*
Your answer
Emergency Contact & Number:
*
Your answer
Medical Information:
Medical or other information we need to know about your child. Please include any allergies to food or medication
Medical Condition / Allergies to any Medicine (if none please put "None")
*
Your answer
Food Allergies (if none, please put "None")
*
Your answer
Dismissal Information: Who may pick up your child / children at the end of each VBS Day?
*
Your answer
Additional Information:
Do you attend church? If so where?
Your answer
If you are visiting our church, who are you 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 in church publication for the purpose of promotion?
*
Yes
No
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
