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VBS 2017 Pre-Registration Form
*
Indicates required field
Child's Name
*
First
Last
Parent/Guardian Name
*
First
Last
Child's Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mailing Address
*
Mailing Address (if different)
Home Phone Number
*
Work Phone Number
*
Cell Phone Number
*
Email
*
What is your child's age?
*
5
6
7
8
9
10
11
12
Must be 5 years old by June 1, 2017.
Last grade completed in school:
*
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Must have completed Pre-K thru 5th Grade as of May 2017!
Does child have medical or allergy needs?
*
Yes
No
Medical or other information we need to know. (Please include any food allergies.)
List Medical Needs
*
Emergency Contact #1
*
Emergency Contact #2
*
Who may pick up your child at the end of each VBS day?
*
Does your child attend Sunday School? If so, where?
*
IF you are visiting our church, who are you a guest of?
*
May we have permission to photograph your child?
*
Yes
No
Photo promotion
*
Yes
No
May we have permission to use your child's photograph for the purpose of CRBC promotional content?
Submit
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