ST. PAUL - NEW PARIS VBS REGISTRATION 2025

301 East Main St. New Paris, OH 45347
Saturday, June 28, 2025 10am - 2pm Ages 3 (Must be potty trained.) to 12 years of age. For more information, contact Debbie Shaeffer at 937 478 3140.
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
Last Grade Completed In School
Parent / Guardian Name

First NameLast Name
Contact Information

Home PhoneWork Phone
Email Address
example@example.com
EMERGENCY CONTACTS ----------- (NOT LISTED ABOVE). NAMES & PHONE #
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MEDICAL INFORMATION ----------- Please list any medical information we need to know INCLUDING any allergies.
Does your child attend church? If so, where?
May we have permission to do face painting?
May we have permission to photograph your child?
May we have permission to use your child's photograph for the purpose of promotion?
DISMISSAL INFORMATION -------- Who may pick up your child at the end of the day?
Should be Empty: