Child's Name:	*
Parent/Guardian Name:	*
Address	*
Home Phone:	*
Work Phone:
Mobile Phone:
Email Address:
Child's Birthdate:
Last Grade Completed:	*
Emergency Contact Info:	*
Who may pick up the child at the end of VBS each day?:	*
Do you 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 or No:	*
May we have permission to use your child's photograph in church publications for the purpose of promotion?:	*
T-Shirt size:	*
Security code:	*

* indicates a required field