Child's Name
Parent/Guardian Name 
Address 
Phone Number
Home      Work      Cell 
E-mail 
Age Information:
Birth date
Last Grade completed in school 
Medical Information:
Medical or other information we need to know. (Please include any food allergies.)

Emergency Contact: (Other than parent/guardian listed above)
Name:     Phone number 
Name:     Phone number 
Dismissal Information:
Who may pick up your child at the end of each VBS day? (Other than parent/guardian listed above.)

My child will need to ride the church bus  (Check if needed)