Vacation Bible School Registration

Child's Information
Name
Age
Date of birth
Grade (for fall 2010)
Sex	Male Female
Child's address
City
State
Zip
Parent/Guardian Information
Name
Phone
Cell
Email
In case of emergency, please contact:
Name
Phone
Relationship to child
Name
Phone
Relationship to child
Does your child have any medical conditions(s) that we should be aware of, such as, allergies, medications, etc?  If so, please explain.
Siblings who will also be attending VBS
Please complete a separate form for each child attending.
Please complete this form with your signature by typing your complete name and date in the fields below.
Name
Date