2010 VBS Registration
Child’s name: _____________________________________________________
Parent/Guardian name: _____________________________________________
Address: _________________________________________________________
Home Phone: ______________ Cell Phone: __________________________
Home email address: _______________________________________________
Child’s age: ___________ Last school grade completed: __________________
In case of emergency (if parent/guardian cannot be reached) please contact:
Name: __________________________________________________________
Telephone: _______________ Relationship to child: ___________________
Please list any allergies (including food allergies) the VBS staff should be aware of:
Person who will pick up child at the end of every VBS day:
Name:___________________________________________________________
Phone number: ________________ Cell Phone number: _________________