2023 Vacation Bible School Registration Form

Childs Name:*
Phone Home:*
Phone Work:
Phone Cell:*
Last grade completed in school:*
If preschool age, please provide birthdate:
Babies-Age 6 will dismiss at 8:45 pm each evening.
Medical Information: Information we need to know (include any food allergies). If the Child has no allergies please write none:*
Emergency Contact: Name:*
Emergency Contact: Phone:*
Dismissal Information: Who will pick up your child at the end of VBS each night?*
May we have permission to photograph your child?*
May we have permission to use your child's photograph for the purpose of promotion?*
Signature of Parent/Guardian: *