Vacation Bible School Registration

Child's Name *
Child's Name
Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
Include mailing address on line 2 if different
Home Phone (Primary) *
Home Phone (Primary)
Cell Phone
Cell Phone
Work Phone
Work Phone
Age Information *
Age Information
Birth Date
Medical or other information we need to know. (Please include any allergies.)
Emergency Contact 1 Name *
Emergency Contact 1 Name
Emergency Contact 1 Phone Number *
Emergency Contact 1 Phone Number
Emergency Contact 2 Name
Emergency Contact 2 Name
(optional)
Emergency Contact 2 Phone Number
Emergency Contact 2 Phone Number
(optional)
Who may pick up your child at the end of each VBS day?
May we have permission to photograph your child? *
May we have permission to use your child's photograph for the purpose of promotion? *