June 4-7 2023 6:00 pm – 8:30pm nightly Register Below VBS registration 2021 Child's Name Parent/Guardian Name Address Mailing Address (if different) Contact Information Home Work Cell Email Address Age Information Birth Date Last Grade Completed in School Medical & Emergency: Medical Information Medical or other information we need to know. (Please include any food allergies.) Emergency Contact 1 Emergency Contact 1 Phone Emergency Contact 2 Emergency Contact 2 Phone WHO MAY PICK UP YOUR CHILD AT THE END OF EACH VBS DAY? DOES YOUR CHILD ATTEND SUNDAY SCHOOL? WHERE? MAY WE HAVE PERMISSION TO PHOTOGRAPH YOUR CHILD? YesNo MAY WE HAVE PERMISSION TO USE YOUR CHILD’S PHOTOGRAPH FOR THE PURPOSE OF PROMOTION? YesNo Date If you are human, leave this field blank.