REGISTRATION FORM
(one per child)

Child’s name _______________________________________________________

Child’s age ______ Date of birth ____________ Last school grade attended _____

Parent(s) __________________________________________________________

Street Address _____________________________________________________

City ____________________________________________ State _____________

Home telephone number (_____) ____________________

Parent/caregiver cell phone number (______) _______________________

Home email address _________________________________

Home church ____________________________________

Crew number or name (for VBS staff use only ______________

Allergies or other medical condition _____________________________________

In case of emergency contact __________________________________________

Phone # _____________________________________________

Relationship to child ____________________________________