Vacation Bible School – 2019

Childs Name *

Parent/Guardian Name *

Address (street, city, st, zip) *

Mailing Address (if different)

Home Phone

Work Phone

Cell Phone

Email address *

Birthdate * (YYYY-MM-DD)

Last grade completed in school *
---Pre-SchoolKindergarten1st2nd3rd4th5th6th

Medical or other information we need to know. (Please include any food allergies.)

Emergency Name *

Emergency Phone *

Emergency Name 2

Emergency Phone 2

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 a guest of?

May we have permission to photograph your child? *
YesNo