VBS STUDENT REGISTRATION

Parent/ Guardian Name(s)

Email:

This address will receive a confirmation email

Mobile:

Home Phone:

Address:

Preferred Method of Contact:

Child's Name:

Child's Age:

Child's Date of Birth:

Child's Name:

Child's Age:

Child's Date of Birth:

Emergency Information

Emergency Contact #1

Phone:

Emergency Contact #2

Phone:

Doctor:

Phone:

Allergies or Special Needs:

Additional Information:

Dismissal

Who may pick up your child or children at the end of each VBS day?

Name:

Phone:

Name:

Phone:

Description

Please fill out the VBS Registration Form and click submit. Thank you for bringing your child/ children to Vacation Bible Schoo!.