VBS Registration Form

Please provide the following information about your child.

Child's Name*

Child's Birthday*

School Grade Completed*

Does your child have any allergies?* yes no

If yes, please list here/provide additional information:

If you have multiple children that will be attending VBS, please list their info below:

Child 2:

Child's Name

Child's Birthday

School Grade Completed

Does your child have any allergies? yes no

If yes, please list here/provide additional information:

Child 3:

Child's Name

Child's Birthday

School Grade Completed

Does your child have any allergies? yes no

If yes, please list here/provide additional information:

Please provide the following contact information for yourself:

Parent's Name(s)*

Address*

Email Address*

Phone Number*

Additional Phone Number

Home Church (if applicable)

In case of emergency with your child(ren), please specify who we should contact:

Emergency Contact Name*

Emergency Contact Phone*

We will be taking pictures during our time together with your child(ren) at VBS, and we would like to be able to use the photographs on our website and social media accounts.

Do you grant permission for us to use your child(ren)'s photograph?* yes no

I certify that I am the legal parent or guardian for the child(ren) listed on this form. I also certify that I am legally able to give permission for the child(ren)'s photographs to be used.

Please type your name*

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