VBS Registration

Child's Name(Required)

First Last

Parent/Guardian Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Mailing Address (if different)

Street Address City State ZIP Code

Cell(Required)

Home

Work

Email(Required)

Birth Date(Required)

Last Grade Completed in School(Required)

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

Names & Phone Numbers(Required)

Who may pick up your child at the end of each VBS day?(Required)

Does your child attend church? If so, where?

If your child is visiting our church, who are they a guest of?

May we have permission to photograph your child?(Required)

Yes

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

Yes