EmailMe Form - COMMUNITY VBS 2013

Home Church:
If you or your family does not have a home church, please list "none". *

Child 1

First Last

Date of Birth

Gender

Male

Female

T-SHIRT SIZE
(**FREE - Must
Pre-register by May 19th)

Grade Completed
Child must be 4 years old (Aug 2013) to participate

Child 2

First Last

Date of Birth

Gender

Male

Female

T-SHIRT SIZE
(**FREE - Must
Pre-register by May 19th)

Grade Completed
Child must be 4 years old (Aug 2013) to participate

Child 3

First Last

Date of Birth

Gender

Male

Female

T-SHIRT SIZE
(**FREE - Must
Pre-register by May 19th)

Grade Completed
Child must be 4 years old (Aug 2013) to participate

Child 4

First Last

Date of Birth

Gender

Male

Female

T-SHIRT SIZE
(**FREE - Must
Pre-register by May 19th)

Grade Completed
Child must be 4 years old (Aug 2013) to participate

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Parent/Guardian *

First Last

Phone/Cell *

### - ### - ####

Email *

Parent/Guardian

First Last

Phone/Cell

### - ### - ####

Email

Emergency Contact *

First Last

Emergency Phone *

### - ### - ####

Special Needs/Allergies/Other Concerns

Permission for photos: *

By checking this box I am giving permission for my child/children's photos to be used for promotional purposes.

My child may not have any photos taken.

Parental/Guardian Responsibility *

By checking this box I am over 18 and responsible for the child/children listed on this form and will not hold churches sponsoring this event responsible for injury/accident.