Vacation Bible School Registration

Child's Name (required)

Parent/Guardian Name (required)

Street Address (required)

City (required)

Zip Code (required)

Home Phone # (required)

Cell Phone # (required)

Your Email (required)

Child's Date of Birth (required)

Child's Last Grade Completed (required)

Medical Information, such as food allergies, special needs, etc. (if any)

Emergency Contact {name & phone #}, other than parent/guardian listed above (required)

List who may pick up your child at the end of VBS each night (required)

Does your child attend a church? If so, where? (required)

Is your child a guest of a friend? If so, who is the friend? (required)

May we have permission to photograph your child participating in VBS activities? (required)

May we have permission to use a photograph of your child at VBS for the purpose of promotion? (required)

Any additional information you would like for us to know

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