Registration Form
$5.00 Registration Fee Per Child
Child’s Name: ___________________________________________________________
Address: ________________________________________________________________
Age: _________ Birthdate: _____________ Last School Grade Completed: _________
Parent/Guardian Phone: Home ___________ Work ___________ Cell _____________
Emergency Contacts:
Name: ______________________________________ Phone: _______________
Name: ______________________________________ Phone: _______________
Names of Persons with Permission to Pick up this child from VBS:
Name: ____________________________ Relationship: ____________________
Name: ____________________________ Relationship: ____________________
Name: ____________________________ Relationship: ____________________
Allergies/Medical information/Food Needs/Other Concerns:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
“Jesus Christ is Living Water for our Bodies and our Souls”
Clean Water for All God’s Children!
Vacation Bible School
(insert your church name here)
Rev. 1/06