FIRST VISIT
Teachings
Ministries
Men's Ministry
Women's Ministry
Children's Ministry
Youth Ministry
Prayer Ministry
Worship Ministry
United Young Adult's Ministry
Skate Church
SERVE
EVENTS
Outreach
Giving
FIRST VISIT
Teachings
Ministries
Men's Ministry
Women's Ministry
Children's Ministry
Youth Ministry
Prayer Ministry
Worship Ministry
United Young Adult's Ministry
Skate Church
SERVE
EVENTS
Outreach
Giving
VBS 2017 Reg Form
Student information
Child's Name
*
Child's Name
First Name
Last Name
Parent/ Guardian Name
*
Parent/ Guardian Name
First Name
Last Name
Address
*
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
Phone
(###)
###
####
Email Address
*
Age information
Birthdate
*
Birthdate
MM
DD
YYYY
Last Grade Completed/ Age
*
4 Years
5 Years
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Medical Information
Medical or other information we need to know. Please include food allergies.
*
Emergency Contacts
Other than listed above
Emergency Contact #1
*
Emergency Contact #1
First Name
Last Name
Contact #1 Phone Number
*
Contact #1 Phone Number
(###)
###
####
Emergency Contact #2
Emergency Contact #2
First Name
Last Name
Contact #2 Phone Number
Contact #2 Phone Number
(###)
###
####
Dismissal Information
Who may pick up your child at the end of each VBS day? (Please list anyone that might be a possibility, your child will not be released to anyone not listed.)
Approved to pick up
*
Approved to pick up
Approved to pick up
Approved to pick up
other information
Does your child attend Sunday School/ Church? If so, where?
*
If your child is visiting our church, who is he/she a guest of?
May we use photographs of your child for promotional purposes?
*
Yes
No
Thank you!