2010 VBS Registration
If you or your child would like to participate in VBS, please complete the following form. If you are under 18, please have your parent or guardian complete the form.
*First Name:
*Last Name:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
Home Phone:
(555-555-5555)
Work Phone:
(555-555-5555)
Cell Phone:
(555-555-5555)
Email:
*Birthday:
(12/31/2006)
*Last Grade Completed:
Allergies, Medical, & Special Needs:
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
(555-555-5555)
Emergency Contact Name (2):
Emergency Contact Phone (2):
(555-555-5555)
*Authorized Pickup #1:
Authorized Pickup #2:
Authorized Pickup #3:
Authorized Pickup #4:
Are you a member of this church?
Guest of:
Do you attend Church?
If so, where?
May we have permission to photograph your child?
May we have permission to use your child's photograph in church publications?
T-Shirt Size:
Comments:
Gender:
* Required