2010 VBS Online Registration

*** Please note that this e-form does not constitute an agreement by us to accept responsibility for your child during VBS ***

You **must** come in and confirm registration in person on the first night you bring your child to VBS.

The purpose of this form is to:

1. Expedite the registration process for you and your child

2. Give us early estimates of numbers for VBS

Thanks! We look forward to seeing you!

2010 VBS Online Registration Form

General Information:

Child's Name:

Parent/Guardian Name:

Address:

Phone Numbers:

Home:

Work:

Cell:

Email:

Your email address:

Age & Medical Information:

Birth date:

Last Grade Completed:

Medical Information: Medical or other information we need to know. Please include any food allergies:

Emergency Contacts:

Name: Number:

Please list all persons authorized to pick your child up at the end of VBS, including yourself. Names not on the list will not be allowed to pick up your child.

Other information:

Do you attend church? If so, where?

If you are a visitor, are you a guest of someone? Who?

Do we have permission to photograph your child?

Yes

May we have permission to use your child's photograph in church publications for the purpose of promotion?

Yes

Child's T-Shirt Size:

Large Medium Small Child Large Child Medium Child Small