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Child Information*
If you'd like to register more than one child, please click the plus button to complete the additional fields.
Child's Name Birthdate Last Grade Completed in School
Contact Information
Parent/Guardian Name*
First Last
Address*
Street Address City State ZIP Code
Home Phone
Work Phone
Cell Phone*
Email*
Medical Information
Medical or other information we need to know. (Please include any food allergies or any other allergies.)
Emergency Contacts <em>(other than listed above)</em>
Include Names and Phone Numbers
Dismissal Information*

Who may pick up your child at the end of each VBS day?
Other Information
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?*
- Yes
- No
May we have permission to use your child's photograph for the purpose of promotion?*
- Yes
- No

Child's Name	Birthdate	Last Grade Completed in School