Vacation Bible School

July 5^th-July 9^th, 2010
8:45 AM – 12:15 PM

Registration Form

Child’s Name ____________________________________________

Child’s Street Address _____________________________________

Child’s City__________________ State______ Zip____________

Child’s Home Phone #_____________________________

Parents Name(s) __________________________________________________

Parents Name(s) __________________________________________________

Who to contact in case of an emergency ____________________________________

Relation to the child: Parent, Grandparent, Aunt/Uncle, Guardian, Babysitter, Neighbor

Phone # ________________________________

Any known Allergies? ________________________________________________

Any known medical conditions?_________________________________________

My child will attend VBS on: ___Mon ___Tues ___Wed ___Thur ___Fri

School grade just completed _______ Child’s age_______ Child’s birthday________________

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Office use only:

Group the child is placed in ____________________________________

READ COMPLETELY BEFORE FILLING OUT THE FORM

Should you have more than one child participating in VBS, please use a separate form for each.

However, only on the youngest child’s form please enter all the pertinent information completely

and on all the other children you will only need:

name, parents name, emergency contact # phone number,

known allergies and medical conditions, dates attending and child’s grade, age and birth date information.