Child's Name Child's First Name Child's Last Name Child's Address Address Address 2 City State Zip Code Child Info Birthdate Last Grade Completed Please let us know any special information we may need to know about. Food or other allergies, Special needs, or other conciderations. Special Food/Medical Info Does your child attend church? If so, where? May we have permission to photograph your child during VBS? Yes No May we use your Child's photo for the purposes of promotion? (Website, Facebook, etc.) Yes No Will your child need a ride to attend VBS? Yes No Parent/Guardian Name Parent/Guardian First Name Parent/Guardian Address Address Address 2 City State Zip Code Contact Info Primary Phone Secondary Phone Email Address Emergency Contacts (other than above) Emergency Contact Name Emergency Contact Phone Additional Contact Information Dismissal Information Please let us know who other than the listed guardian can pick up you child at the end of VBS each day? Please list the names of those you approve to pick up your child submit Please turn on javascript to submit your data. Thank you! Powered by BreezingForms
Please let us know any special information we may need to know about.
Food or other allergies, Special needs, or other conciderations.
Please let us know who other than the listed guardian can pick up you child at the end of VBS each day?
