Child's Name (required)

Parent/Guardian's Name (required)

Address (required)

Your email (required)

Home Phone Number (required)

Cell Phone Number

Date of Birth (required)

Age (required)

Last Grade Completed (required)

Home Church

Allergies/Food & Medical/Other (type "none" if none)

Do we have permission to photograph your child?
 Yes No

If we have permission to photograph your child, may we put the photos on our church website and/or our Facebook page?
 Yes No

Emergency Contact Name (required)

Emergency Contact Phone Number (required)

Emergency Contact Name

Emergency Contact Phone Number

Please list Name(s) of Person(s) who may pick up this child from VBS

Any other information about your child you feel VBS staff should be aware of: