Child's Name (required)

Parent's/Guardian's Name (required)

Address (required)

Mailing Address (if different from previous)

Primary Phone Number (required):

Secondary Phone Number:

Email Address (required):

Need Van Pickup (required)?
YesNo

Pickup Location:

Age of Child (required):

Last Grade Completed in School (required):

Medical Information (please include any food allergies)

Emergency Contact Information (other than those listed above)

Name:

Phone Number:

Emergency Contact Information (other than those listed above)

Name:

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 is he/she a guest of?

May we have permission to photograph your child?
YesNo

May we have permission to use your child's photograph for promotions?
YesNo

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