Your Name (required)

Grade Completed(required)

Birthdate (required)

Age (required)

Address

Phone

Cell Phone (required)

Emergency Contact(s), including phone number(s)

Food Allergies or insect reactions. Please list all. If do not have any, just type None.

Medical Concerns. If No, please type No.

Siblings attending VBS? (Names and ages):

Do you currently attend church? If so, where?

People who may pick up your child
(required)

VBS Leaders have permission to photograph my child(ren) for any lawful purpose associated with VBS. Photos may be posted on church website and/or Facebook, bulletins, and newsletters.