VACATION BIBLE SCHOOL 2023 REGISTRATION Jesus: Savior, Master, Friend (ages 3-12)

CHILD'S NAME STREET ADDRESS CITY STATE ZIP EMAIL PRIMARY PHONE NUMBER PARENT'S /GURADIAN'S NAME EMERGENCY CONTACT NUMBER ALLERGIES OR SPECIAL NEEDS MEMBER OF WHICH CHURCH GRADE COMPLETED DATE OF BIRTH (MM/DD/YYYY) AGE 3 4 5 6 7 8 9 10 11 12 NAMES OF THOSE WHO MAY PICK UP YOUR CHILD MAY WE TAKE YOUR CHILD'S PHOTO FOR A CRAFT THEY WILL MAKE AND TAKE HOME? Yes No MAY YOUR CHILD'S PHOTO BE USED IN THE NEWSPAPER ABOUT OUR VBS? Yes No