VBS Registration Form

Please fill out one VBS registration form per child.

An (*) denotes a required field.

*Child's Name:
*Age:
Grade Completed:


*Address:

*City: *State: *Zip:


*Parent(s):
*Phone Number:
Cell Number:
*Email:
Do you attend a Church?
Name of Church:


*Emergency Contact #1:
*Emergency Phone Number #1:
*Emergency Contact #2:
*Emergency Phone Number #2:


*Who will pick up child at noon?:


If this person can not pick up the child please tell the Director the name of the person who will be picking up your child.
This person will have to show ID or your child will NOT be released. Minors picking up children must be at least 17.
THIS IS TO PROTECT YOUR CHILD!

List any problems your child may have such as allergies, asthma, etc. or if they carry inhalers or meds:


Music CD's with the VBS songs may be purchased through distributor.
You can reserve a CD at $2.00 each. You must pay for and pick these up the first day of VBS.

How many CD's would you like to reserve?:

 


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