VBS REGISTRATION

 

HERO-CONTRAL-2017 VBS – REGISTRATION FORM

 

 

 

Please print information:

 

Child’s name:                         Date of birth:             Age:     Grade completed by June 2014:       Medical/allergy info:

 

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

Adult’s name, if participating: __________________________ Class you are interested in: _________________________________

 

Parent/Guardian’s name: ______________________________________________________________________________________

 

Address: ____________________________________________________________________________________________________

 

E-mail address: ______________________________________________________________________________________________

 

Phone numbers:  (cell) _________________________ (home) __________________________

 

Home church: (if applicable) _____________________________________________________

 

Emergency contacts:

Name:_________________________________________________________  Phone ______________________________

 

Name: ________________________________________________________  Phone ______________________________

 

Dismissal information:  Names of persons who may pick up this child from VBS: _________________________________

 

___________________________________________________________________________________________________

 

Are parents helping with VBS? ______ If yes, where? _______________________________________________________

How did you hear about VBS?___________________________________________________________ 

 

VBS Leaders have permission to photograph/video the participants for any lawful purpose associated with this VBS program.

 

Parent/guardian’s signature: _________________________________________________ Date: ____________________

 



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