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Child Registration Form
*Child's Name:
*Parent or Guardian Name:
*Street Address:
*City & State:
*Zipcode:
Mailing Address (if different):
*Home Phone Number:
Cell Phone Number:
E-mail Address:
*Birthdate:
*Last Grade Completed in School:
*Medical or Other Information (Including Allergies):
*#1 Emergency Contact Name:
*#1 Emergency Contact Phone Number:
*#2 Emergency Contact Name:
*#2 Emergency Contact Phone Number:
*Who may pick up your child at the end of each VBS day?:
Does your child attend Sunday School? If so, where?:
If your child is visiting our church, who are they a guest of?:
*May we have permission to photograph your child?:
*May we have permission to use your child's photograph for the purpose of promotion?: