Vacation Bible School 2010 Registration

 
CHILD INFORMATION
Child's Name:  
                                           (last name)                                                 (first name)
Date of Birth:   Age:   Gender:   Boy  Girl 
                                   (mm/dd/yyyy)
Grade entering in Fall:  K4/K5   1st   2nd   3rd   4th   5th   6th
Street Address:    Apartment:
 
                 City:     Zip:   
 
Allergies/Medical Alerts: 
 
 
Home Church:  
Attend Regularly? Yes  No
 
T-Shirt Size:   Youth:   XS   S  M   L   XL  
                       Adult:   S     M  L   XL  
 
PARENT/GUARDIAN INFORMATION
Parent/Guardian:  
 
                 Email:   
 
            Phone(s):       
                                 (home phone)                 (cell phone #1)              (alternate phone) 
 
EMERGENCY CONTACT INFORMATION
           Contact Name:     
Contact Relationship:  Immediate Family    Close Friend 
         Contact Phone:       
                                          (phone #1)                    (phone #2)  
 PICK-UP INFORMATION
Names of authorized people to pick-up
your child (name & phone #; one name per line)?
 
MISCELLANEOUS INFORMATION
Additional comments...