Name: VBS (2024)
Start: 2024-06-10T00:00:00-04:00
End: 2024-06-14T23:59:59-04:00

Child's Name*

First Last

Address*

Street Address City State ZIP Code

Home Phone*

Child's Birth Date*

Child's Age Category:*

Gender*

Male
Female

T-Shirt Size*

What church does child regularly attend?*

Name of Parent Completing this Form*

Prefix First Last Suffix

Parent's Cell Phone Number:*

Parent's Email:*

Enter Email Confirm Email

Emergency Contact or Other Parent's Name:*

First Last

Cell Number for Emergency Contact or Other Parent:*

Name of Child's Physician:*

First Last

Physician's Phone Number:*

Allergies & Medical Concerns:

List any allergies, food or otherwise, that your child has along with any medical concerns that we should be aware of to ensure your child’s safety.

Use of Photographs:*

I give permission for photographs of my child to be taken and used in future promotional materials on the church website or in hard copy form. Your child’s name will never be published with the photo.

Yes
No

VBS (2024)

June 10 – June 14

VBS Kids Registration

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