Child's Name * First Name Last Name Parent's Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Birth Date * MM DD YYYY Age * Last Grade Completed * Medical Information * Medical or other information we need to know. Please include any food allergies. Emergency Contact * Include name, phone number, and relationship. Dismissal Information * Who may pick up your child at the end of each VBS day? Does your child attend church? * Yes No If yes, what is the name of the child's church? If your child is visiting our church, who is he/she a guest of? Do we have permission to photograph your child? * Yes No May we have permission to use your child's photographfor the purpose of promotion? * Yes No Thank you!
