2011 VBS REGISTRATION Form
Child's Name
Boy
Girl
Street Address
City:
State:
Zip:
Home Telephone:
E-mail:
Home Church
Child lives with during the summer:
Both Parents
Mom
Dad
Other Guardian
Child's Date of Birth
Grade of school complete by June 2011
** Must be 4 years old by June 27, 2011
Emergency Contact Information
Parent or Guardian Name
Relationship:
Home/Work Phone:
Cell Phone:
Other Contact Name
Relationship:
Home/Work Phone:
Cell Phone:
Dismissal Info:
Name(s) of person (s) who may pick up this child from VBS:
Special Instructions
Allergies /
Medical Conditions /
Other
Be a Volunteer
I can volunteer at VBS the following days (8:45 am - 12:30 pm)
All Week
Monday
Tuesday
Wednesday
Thursday
Friday
I would like to help with the following age group
Preschool
Elementary
I would like to help with one of the activity stations
Crafts
Drama
Recreation
Snacks
Wherever I am needed
I can help with decorations before VBS
Name
2011 VBS REGISTRATION Form