Road Trip VBS Registration Form

Road Trip VBS Registration Form

We would love to have you join in on the Kingdom Kids' Road Trip at Smithfield Church of God on August 9th from 10 am - 4 pm, geared towards ages 4-12. We are looking forward to a day full of fun with God's direction. We will be having a devotion, craft, food, games, and lots of laughs as we venture through God's Word. We look forward to being on the go with God together!
Institution Name
STUDENT INFORMATION
Name*

First NameLast Name
Birth Date *

MonthDayYear
Date
Home Church (if any)
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian*

First NameLast Name
Relationship to child*
Phone Number*
Format: (000) 000-0000.
Alternate Guardian #1

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Medical Information
Please list all allergies -- or type "none" if there are none*
YesNo
Please list all medical concerns -- or type "none" if there are none*
Additional Information
YesNo
By submitting this form, I ackowledge I have read and understand the above information.
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Medical Information