Child's Name

Parent/Guardian Name

Address

Phone Numbers:
Home 

Work  

Cell    

E-mail 

Age Information:
Birth date (for preschoolers)
(mm/dd/yy)
or
List last grade completed in school

Medical information:
Please list or describe medical or other information VBS workers need to know, including any food allergies

Emergency contact:
Name

Phone number

Name

Phone number

Dismissal information:
Who may pick up your child at the end of each VBS day?

Other information:
Do you attend Sunday School?     Yes     No
If so, where?