VBC form

Vacation Bible School Registration Form 2017

* Indicates required field

Child's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone # *

Birthdate *

Age *

Grade in September 2017 *

Home Church, if any *

Parent/Guardian's Name *

First

Last

Home/Work/Cell phone # *

Emergency Contact Name *

Emergency Contact Phone # *

Health Card Number *

Version Code on Health Card *

Family Doctor *

Doctor's Phone # *

Any Allergies? Please specify *

Any Health/Other Information we should know? *

Will medication be required while at VBC? *

YES NO

If yes, please specify *

Would you be able to help with snack time by coming and serving snack? *

YES NO

Please initial *

Date *

By submitting this application, the parents/guardians of the child agree on behalf of themselves and the child that any photographs taken of the child may be used without charge by the church/camp in any promotional material, unless a written letter is submitted that states otherwise.

Submit