Contact Info

Home Phone

Work Phone

Cell Phone

Email Address

Age Information

Child's Birth Date

Child's Last Grade Completed in School

Please provide any medical or other important information we need to know. Please be sure to include any food allergies.

Please list the Names and Phone Numbers of any Emergency Contacts below

Contact #1 Name

Contact #2 Name

Contact #3 Name

Contact #1 Phone

Contact #2 Phone

Contact #3 Phone

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

Does your child attend Sunday School?

Yes No

If your child is visiting our church, who are they a guest of?

May we have permission to photograph your child?

Yes No

May we have permission to use your child's photograph for the purpose of promotion?

Yes No