EmailMe Form - PAPBC VBS 2016 Registration

Parent/Guardian Name *
First Last
Child's Name *
First Last
Gender *
Last grade COMPLETED *
Child's Date of Birth *
MM / DD / YYYY
Our VBS is for children 5yrs old through 5th grade. Must be 5yrs old by 8/3/15
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Parent/Guardian Email *
For confirmation.
Home Phone Number *
### - ### - ####
Cell Phone
### - ### - ####
Work Phone
### - ### - ####
Emergency Contact Name *
First Last
Emergency Contact Phone *
### - ### - ####
Medical or other information we should know about your child. (Please inlclude any allergies.)
Who may pick up your child from VBS *
Please list anyone who is allowed to pick up your child from VBS and their RELATIONSHIP to child.
Do you attend church and Sunday School regularly?
Yes
No
If so, what church?
Would you be interested in knowing more about our church?
Yes
No
May we have permission to photograph your child?
Yes
No
May we have permission to video your child for our VBS DVD?
Yes
No
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