Please fill out this form and sumbit when finished.  We must have one form for each child.  Please repeat process for addional children.

Child's Full Name:

Parent/Guardian First Name:

Parent/GuardianLast Name:

Address Street 1:

Address Street 2:

City:

State:

ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code:

(5 digits)

Daytime Phone:

Evening Phone:

Cellular Phone:

Email:

Age/Grade:
Age (for preschoolers) or last completed grade.

Medical Information:
Medical or other information we need to know.  (Please include any food allergies.)  If none, please type none in box.

Emergency Contact Name:

Emergency Contact Phone:

Emergency Contact Name 2:

Emergency Contact Phone 2:

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

Do you attend Sunday School?:

YesNo

If so where?:

If you are visiting our church, who are you a guest of?:

May we have premission to photograph your child?:

YesNo

May we have permission to use your childs photograph in church publications for the purpose of promotion?:

YesNo

Comments:

Enter comments here!