VBS Child Registration

Please complete one form per Parent/Guardian. If Parent/Guardian and contact information is different, please complete an addional registration for.

* = Required information

CHILD INFORMATION
1st Child's Name:	*
Age:	*
Last Grade Completed:	PreK     K     1     2     3     4     5   *
Friend child would like to be with:
2nd Child's Name:
Age:
Last Grade Completed:	PreK     K     1     2     3     4     5
Friend child would like to be with:
3rd Child's Name:
Age:
Last Grade Completed:	PreK     K     1     2     3     4     5
Friend child would like to be with:
Please use the space provided to describe any allergies or medical conditions your child/children have that we need to be aware of.
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name:	*
Address:	*
City:	*
State:	*
Zip:	*
Email Address:
Phone #:	*
Emergency Contact Name:	*
Emergency Contact Phone #:	*
Home Church:
Comments/Additional Information: