VBS Registration

Child’s First Name* (as it is to appear on name tag):

Child’s Last Name*:

Grade Completed*:


(Note: Students are grouped by age/grade level, not by friends and relatives.)

Custodial Parent(s)*:


Home Phone*:

Cell Phone(s):


Do you attend church?
If so, name of church?:

How did you find out about our VBS?:

Child will be able to attend the closing program on Friday evening:

Is this student the oldest / only child from family at VBS?

VBS Song CD is available for $2. If you would like one, please pay teacher at the registration table of family’s oldest child.

Who will promptly pick up child at noon?
List all people who could conceivably pick up your child. Be sure to tell them that we may ask for identification to protect your child. Anyone signing out a Pre-K to 4th grade child must be at least 17 years old. (VBS workers, please list other people in your department if you do not have family or friends available to pick up your child.)

First Name*:
Last Name*:
Relation to Child*:

First Name:
Last Name:
Relation to Child:

First Name:
Last Name:
Relation to Child:

List / Select Allergies and Medicines:
***Must also sign up at allergy table at reg.***
dairywheatchocolatesoynuts/peanut butterasthmabee stingslatexneomycin

Does child carry inhaler / meds?
If so, what?

Additional important information we should know about your child.

Emergency Contacts (must complete). Whom do we call if we can’t reach a parent?

Relation to Child*:
Phone #*:

Relation to Child:
Phone #: