VACATION BIBLE SCHOOL REGISTRATION
VACATION BIBLE SCHOOL REGISTRATION

* First Name:
* Last Name:
Address:
City:
State / Province
Zip Code:
* Phone:
* Email:
Ages: Toddlers – 16 yrs. (Toddlers MUST be potty-trained)

STUDENT INFORMATION
Please submit a separate registration form for EACH student
* STUDENT'S FIRST NAME
* STUDENT'S LAST NAME
* Student's Age
* Last Grade Completed
Student's Address (if different from above)
City, State, Zip (if different from above)
Home Phone Number

ADDITIONAL INFORMATION
Person responsible to pick-up student after VBS
Their phone number:
Relationship to child
Please be advised that students will be dismissed PROMPTLY at 12:00 noon each day. Please be sure that the person responsible for picking up your child is at the church between 11:50 and 12:00 noon.
* EMERGENCY CONTACT PERSON:
* Emergency Contact Phone Number
Please list any medical conditions or allergies of the student:

* Indicates required entry field