VBS Pre-Registration Form

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Child's Name
*
Parent/Guardian Name
*
Mailing Address (if different)
*
Email Address
Date of Birth
Last grade completed in school
*
Best Phone Number to reach you
*
Medical or other information we need to know. (Please include any food allergies)
*
Emergency Contacts (other than listed above) Names and Phone numbers
*
Other Information (Does your child attend church? If so, where?
If your child is visiting our church, who are they a guest of?
May we have permission to photograph your child?
*

Yes
No
May we have permission to use your child's photograph for the purpose of promotion?
*
Yes
No