2008 Vacation Bible School Registration

Please fill this form out once for each child attending VBS this year.

Child's Information Name
e is required.
Grade Completed A value is required. Birthday A value is required.

Parents' Information Name A value is required.

Street Address A value is required.

City A value is required. State A value is required. ZIP A value is required.

E-mail Address A value is required.

Home Phone A value is required. Alternate Phone A value is required.

Emergency Contact Information Name A value is required.

Relationship to Student A value is required.

Home Phone A value is required. Alternate Phone A value is required.

Safety Information Food Allergies Please select an item.
To which foods is your child allergic? A value is required.

Medical Concerns Please select an item.
Please describe your child's medical concerns: A value is required.

Family Doctor A value is required. Doctor's Phone A value is required.

Who May Pick Up Your Child? A value is required.

Other Information How Did You Hear About Our VBS? A value is required.

Youth T-Shirt Size Please select an item.