2009 Child VBS Registration Form
(one child per registration)


Child's Information
First Name
Middle
Last Name
Age
Gender	Male Female
Last School Grade Completed
Allergies/Medical Information

Parent/Guardian's Information
First Name
Middle
Last Name
Address
City, State ZIP	,
E-mail Address
Home Phone
Cell Phone
Work Phone
Are you interested in helping VBS?	Yes No
If so, what would you like to do?	Meal preparation, serving, or cleanup.
	Event decoration setup or cleanup.
	Class assistant.
	Other:

*Emergency Contacts* Name(s) of person(s) in addition to the parent/guardian who can be contacted in case of emergency.
First Contact Name
Phone

Second Contact Name
Phone

*Dismissal Information* Name(s) of person(s) who may pick up this child from VBS.
Name
Name
Name
Name

2009 Child VBS Registration Form(one child per registration)