VBS Registration July 15 – 19, 2019 | 9:00am – 12:00pm (noon) Please fill out the registration form completely and submit. Child's Name*Parent/Guardian Name*Address* Street Address Address Line 2 City ZIP Code Phone*Alternate PhoneEmail* Age InformationBirth Date*Last Grade Completed*Medical InformationMedical or other information we need to know. (Please include any food allergies.)*Emergency Contact 1Name* First Last Phone*Emergency Contact 2Name* First Last Phone*Dismissal InformationWho may pick up your child at the end of each day?*Other InformationDoes 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?* Yes No May we have permission to use your child’s photograph for the purpose of promotion?* Yes No PhoneThis field is for validation purposes and should be left unchanged.