Child’s Name

Parent/Gaurdian’s Name

VBS Registration Form

Aug. 8-12, at the Presbyterian Church from 9 - 11:30 am

Address

Phone Numbers

Home

Cell

Work

Email

Birth Date

Age

*Open to 3 year olds (out of diapers) through entering the 5th grade.

Last grade completed in school

K

1st

2nd

3rd

4th

Allergies/Medical/Other information that we need to know:

Emergency Contacts (other than listed above)

Name

Name

Phone

Phone

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

Home Church

May we have permission to photograph your child?

YES

NO

May we have permission to use your child’s photograph for the purpose of promotion on Facebook or in the newspaper?

YES

NO

After clicking “Submit” you will be redirected to a Captcha page to verify that you are not a robot.  You will receive confirmation of your registration within two business days.  Thanks for attending!