Child's Name

Parent/Guardian Name

Address

City, State Zip Code

Mailing Address (If different)

Phone Number - HOME

Phone Number - WORK

Phone Number - CELL

Email Address

Birth Date (MM/DD/YYYY)

Last Grade Completed in School

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

Emergency Contacts (Not listed above)

Names and Phone Numbers

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

Does your child attend Sunday School?

If YES, where does your child attend Sunday School?

If your child is visiting our church, who is he/she a guest of?

May we have permission to photograph your child?

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