Child's Name

Parent or Guardians Name

Address

Phone Numbers
Home
Cell
Work

E mail

Age Information
Birth Date
Last grade completed in school

Medical Information
Medical or other information we need to know. (Please include any food allergies)

Emergency Contacts

Name Phone
Name Phone

Dismissal Information

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

Other Information

Do you attend Sunday School? If so, where?
If you are visiting our church, who are you a guest of?

May we have permission to photograph your child? Yes or No

May we have permission to use your child's photograph for the purpose of promotion? Yes or No

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