VBS Registration form (* indicates required item) *Child's First Name *Child's Last Name *Grade Completed Pre-Kindergarten First grade Second grade Third grade Fourth grade Fifth grade Sixth grade or higher *Child's Age *Child's Gender Male Female *Parent's First Name *Parent's Last Name *Street Address *City *State *Zipcode Mailing Address (if different than above) *Contact Phone Number Your Email Address *Emergency Contact Name *Emergency Contact Phone # Let us know if your child has a special friend he/she would like to be with: Any special needs or allergies? Person who will pickup your child (if not parent) Their Phone Number Relationship to child *Permission to use child's photo in church materials? Do you agree to allow photos of your child to be used in church presentations or church promotional materials? Yes No I give my permission for the VBS staff to administer basic first aid to my child in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such an emergency will be paid by me. *Parent Initials