Please Register me for:
q Sunday, July 16 to Thursday, July 22
6:00 p.m. to 8:30 p.m.
(3 years to 4th grade
(06-07)
q LOCK-IN--Friday, July 13th
(7pm)
to Saturday, July 14th (8am)
(5th to 8th grade
(06-07)
Child’s
name_____________________________________
Grade Completed____
Birthday_____________ Age______
Parents’
names_____________________________________
Address__________________________________________
Home
Phone__________________ Cell Phone_____________
Emergency
Contact Person_____________________________
Relationship
to Child_________________ Phone___________
Food Allergies:
Yes____ No_____ Please
list:_______________
Medical
Concerns: Yes____ No______ Explain:_____________
Family
Doctor_________________ Dr’s Phone_____________
Siblings
attending VBS (names and ages
___________________
_______________________________________________
Church
Affiliation___________________________________
People who may pick up my child________________________
***The first night, please bring a clean white t-shirt for your child to make a VBS Memory shirt. Please have it labeled with your child’s name.***