VBS Online Registration

*Child's Name (Ages 4 - 6th grade)** *
Parent/Gaurdian Name *
Address *
Phone Numbers: Home, Work and Cellular *
Email Address
Childs Age *
Kindergarten *	Yes No
Last grade completed in school *
Medical or other information we need to know
Food allergies
Emergency Contact (Name and phone) *
Who may pick up your child at the end of each VBS day? *
May we have permission to photograph your child and to use that photograph for the purpose of promotion? *	Yes No