VBS

Rich Fork VBS June 22 - 25 6:30 - 8:30

VBS is for age 3 by August 31, 2015 through completed 5th grade. If your child is already enrolled at Rich Fork fill in number 1 through 3, then skip to #6

1. Child's Name, First & Last

2. Child's Birth Date

MonthDayYear

3. Grade LEAVING (2014- 2015 School Year)

4. Address, City and Zip

5. Child lives with:

Name of Parent child lives with if only one

email address of #5

6. Emergency Contact Numbers

Father's cell/work

Mother's cell/work

Additional Emergency Contact Person and Number

7. List any food allergies or other medical conditions.

8 May we publicize your child's picture anonymously?