VBS Form

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Fields marked with an * are required

Child’s Name *

Parent/Guardian Name *

Address *

Mailing Address (if different)

Home Phone

Work Phone

Cell

Birth date

Last grade completed in school

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

Emergency Contacts (other than listed above) Names & Phone numbers

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

Does your child attend church? If so, where?

If your child is visiting our church, who is he 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? *