Child Registration Form

March 29, 2017

VBS Form 2017

Childs First Name *
Childs Last Name *
Date of Birth *
Grade Completed *
Age *
Gender *
Parents First Name *
Parents last Name *
Address *
City *

State

Zip Code *
Mailing Address (If different than above)
Home Phone *
Cell Phone
E-mail *
Emergency First Name *
Emergency Last Name *
Emergency Phone *
Special Needs/ Allergies
Person Responsible for Pick up after VBS
Their Phone Number
Relationship to Child
Do you agree to allow photos of our child to be used in church presentation or church promotional materials

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