1 Step 1

VBS 2022 Child Registration

Parent/Guardian NameFirst + Last

Participant Information

Child #1

Child's First Name

Child's Last Name

Birthdate

CHILD #1: Please list any medical or other information we need to know.Please include any food allergies.

0 /

Child #2

Child's First Name

Child's Last Name

Birthdate

CHILD #2: Please list any medical or other information we need to know.Please include any food allergies.

0 /

Child #3

Child's First Name

Child's Last Name

Birthdate

CHILD #3: Please list any medical or other information we need to know.Please include any food allergies.

0 /

Child #4

Child's First Name

Child's Last Name

Birthdate

CHILD #4: Please list any medical or other information we need to know.Please include any food allergies.

0 /

Child #5

Child's First Name

Child's Last Name

Birthdate

CHILD #5: Please list any medical or other information we need to know.Please include any food allergies.

0 /

Child #6

Child's First Name

Child's Last Name

Birthdate

CHILD #6: Please list any medical or other information we need to know.Please include any food allergies.

0 /

Address

Number & Street or PO Box

City

Zip

Parent/Guardian Contact Information

Home Phone

Work Phone

Cell Phone

Emergency Contact(s)

other than parent/guardian

Contact #1

First + Last Name

Phone

Contact #2

First + Last Name

Phone

Dismissal Information

Who may pick up your child at the end of each VBS day?

0 /

Church Information

Do you have a home church that you attend regularly?

YesNo

If so, where do you attend?

If your child is visiting with a friend, who is he/she a guest of?

Permissions

May we photograph your child?

YesNo

May we use your child's photograph for promotional purposes?

YesNo