For grades PreK-5th grade
ages 4-11
Child’s Name
Parent/Guardian Name
Parent/Guardian Name
Address
(street address, city, zip)
Mailing Address (if different)
Contact Information
Work Phone
Cell Phone
Email
example@example.com
Age Information
Birth date
/
Month
/
Day
Year
Date
Grade child will be going into
Medical Information
Is there any medical information we need to know? (Please include food allergies)
Emergency Contact (other than parent/guardian listed above)
Name
Phone
Emergency Contact (other than parent/guardian listed above)
Name
Phone
Dismissal Information
Who may pick up your child at the end of VBS each day?
May we have permission to use your child's photograph for the purpose of promotion?
Yes
No
Does your child attend Sunday School? If so where?
How did you hear about Current Church/VBS 2022?
Submit
Should be Empty: