VBS Sign-Up Form Mount Moriah Independent Fellowship
Psalm 25:4 Shew me thy ways, O Lord; teach me thy paths.
Child's Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade Just Completed
*
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact Name and Phone Number:
*
Names of Guardians Responsible for Drop Off and Pick Up:
*
Please List Any Allergies:
*
I give permission to take photographs and / or video of my child. I grant full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group's aims. Signature:
*
Continue
Continue
Should be Empty: