Vacation Bible School 2017

Vacation Bible School 2017

VBS is available for children 3 years old to 5th grade
E-mail *
How many children are you registering? *
Child Information
First Child
Child's Name *

First Name Last Name
Child's Birth Date *

Month Day Year
Last Grade Completed *
Does the child attend Sunday school anywhere? *

Yes No
Does the child attend Church anywhere? *

Yes No
Where?
Medical or other information we may need to know about the child (including food allergies). *
Second Child
Child's Name *

First Name Last Name
Child's Birth Date *

Month Day Year
Last Grade Completed *
Does the child attend Sunday school anywhere? *

Yes No
Does the child attend Church anywhere? *

Yes No
Where?
Medical or other information we may need to know about the child (including food allergies). *
Third Child
Child's Name *

First Name Last Name
Child's Birth Date *

Month Day Year
Last Grade Completed *
Does the child attend Sunday school anywhere? *

Yes No
Does the child attend Church anywhere? *

Yes No
Where?
Medical or other information we may need to know about the child (including food allergies). *
Fourth Child
Child's Name *

First Name Last Name
Child's Birth Date *

Month Day Year
Last Grade Completed *
Does the child attend Sunday school anywhere? *

Yes No
Does the child attend Church anywhere? *

Yes No
Where?
Medical or other information we may need to know about the child (including food allergies). *
Child Release Information
Parent/Legal Guardian Name *

First Name Last Name
Phone Number *

- Area Code Phone Number

Address *

Names of Persons to which the child (children) may be released to each night after VBS (Please provide at least two) *

First Name Last Name
Full Name *

First Name Last Name
Full Name

First Name Last Name
Full Name

First Name Last Name
Are there any persons to which the child (children) may NOT be released to? *

Yes No
Who may you child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above) *

First Name Last Name
Emergency Contact 1 Phone Number *

- Area Code Phone Number
Emergency Contact 2 (other than parent/guardian listed above) *

First Name Last Name
Emergency Contact 2 Phone Number *

- Area Code Phone Number
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.

I Agree
Should be Empty:

Child Information