Please complete the following form to pre-register for this year's Vacation Bible School.
Parent/Guardian Name
Street Address City State
Zip Code Email Address
Home Phone Cell Phone Work Phone
Do you attend Sunday School No Yes If so, where
If you are visiting our church, who are you a guest of?
Child 1
Name Birthdate 01 02 03 04 05 06 07 08 09 10 11 12 / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Last Grade Completed Preschool Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth
Medical Information (Please list any food allergies.)
Emergency Contact Name Number
Alternate Emergency Contact Name Number
Who may pick up this child at the end of the day?
May we have your permission to photograph this child? Yes No
May we have permission to use your child's photograph in church publications for the purpose of promotion? Yes No
Child 2
Child 3