Vacation Bible School On-Line Registration Form June 23 - 27, 2008 8:45am - 12:15pm
Please fill in all the information below, including dates, for each child #1 Child's First Name Last Name Date of Birth Last Grade Completed Will be attending on: Monday Tuesday Wednesday Thursday Friday List any medical concerns ------------------------------------------------------------------------------------------------------------------------------------------- #2 Child's First Name Last Name Date of Birth Last Grade Completed Will be attending on: Monday Tuesday Wednesday Thursday Friday List any medical concerns ------------------------------------------------------------------------------------------------------------------------------------------- #3 Child's First Name Last Name Date of Birth Last Grade Completed Will be attending on: Monday Tuesday Wednesday Thursday Friday List any medical concerns ------------------------------------------------------------------------------------------------------------------------------------------- Parent's/Guardian Name: First Last Address City State Zip Code Phone Cell Phone Email ----------------------------------------------------------------------------------------------------------------------------------------- In Case of Emergency (when the parents/guardian cannot be reached), contact: Name Phone Cell Phone Relationship to child Doctor Phone Allergies or other medical concerns not listed above ----------------------------------------------------------------------------------------------------------------------------------------- Person(s) allowed to pick up these children at the end of each VBS day. Name: Phone: Cell Phone ----------------------------------------------------------------------------------------------------------------------------------------- Present Church Affiliation Referred by