| Welcome we are so excited that you are going to join us for the BEST WEEK OF THE SUMMER! Remember: VBS is for those kids who have COMPLETED Kindergarten thru 5th grade. |
| *Participant's First Name: |
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| *Participant's Last Name: |
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| *Parent/Guardian Name: |
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| *Email: |
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| *Address: |
__________________________________ |
| *City: |
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| *State: |
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| *Zip: |
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| Home Phone: |
(______)______-________ |
| Work Phone: |
(______)______-________ |
| *Cell Phone: |
(______)______-________ |
| *Birthday: |
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| *Last Grade Completed: |
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| *Gender: |
Male Female (circle one) |
| Allergies, Medical, & Special Needs: |
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| *Emergency Contact Name (1): |
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| *Emergency Contact Phone (1): |
(______)______-________ |
| *Authorized Pickup #1: |
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| *Authorized Pickup #2: |
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| Are you a member of this church?: |
Yes No (circle one) |
| Guest of: |
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| Do you attend Church?: |
Yes No (circle one) |
| If so, where?: |
__________________________________ |
| May we have permission to use your child's photograph in church publications?: |
Yes No (circle one) |
| Comments: |
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| *Preferred Name for Name Tag: |
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