VBS REGISTRATION FORM
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Your Child's Name (required)

Parent's / Guardian Name (required)

Physical address (required)

Mailing address if different

City (required)

Your State (required)

Zip

Phone Number

Work Number

Cell Number

Your Email (required)

Child's Birthdate (required)

Last Grade completed (required)

Medical or other information we need to know (include any food allergies)

Emergency Contact

Phone Number

Emergency Contact 2

Phone Number 2

Dismissal Information: Who may pick up your child at the end of each VBS day?

Other Information: Does your child attend Sunday School? If so, where?

If your child is visiting our church, who is he or she a guest of?

May we have permission to photograph your child?

May we have permission to use your child's photograph for the purpose of promotion?

Any addition information you would like to provide