VBS REGISTRATION FORM (CHILD)

Participant Information
Child Name *
Child Name
Registration Form required for each child
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Name
Parent/Guardian Name
Home Address *
Home Address
Home Phone *
Home Phone
Cell Phone
Cell Phone
(Cell)
Put N/A if no church affiliation
Emergency/Medical Information
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Put N/A if no identified food allergies
Put N/A if no identified medical concerns
Put N/A if no additional special needs
Photograph/Video Allowance *
May VBS leaders have permission to photograph/film your child(ren) for use in a photo/video slideshow?
List all names in the field below