Vacation Bible School

Child's Name

Parent/Guardian Name

Mailing Address

Street Address City, State Zip

Phone Number

Email

Child's Age

Last Grade Level Completed

Medical Information

Any information that we would need to be aware of, including allergies.

Emergency Contacts

Names and numbers of anyone that may be reached in the case of an emergency

Who will pick up child after daily VBS?

Does your child attend Sunday School?

Yes
No

If Yes, please share where

May we photograph your child?

Yes
No

If yes, may we use your child's photograph for promotional purposes?

Yes
No