Student Registration Form for VBS

Child's Name

Child's Age

Grade Entering in the Fall

Child's Name

Child's Age

Grade Entering in the Fall

Child's Name

Child's Age

Grade Entering in the Fall

Parent / Guardian Name

Street Address

Email Address

Contact Number

Emergency Number

Allergies or Special Notes

Who may pick up/sign out your child (besides you)?

Relationship

Doctor's Name & Phone

What church do you currently attend?