Vacation Bible School
July 10-12
Monday-Wednesday, 6:30-8:00 pm
Child’s Name:_______________________    __________________________________             Gender: M or F
                                        First                                              Last                                               circle one
Children must be at least 4 by September 1st and up to entering 6th grade to attend.
Child’s date of birth:____/_____/______                  Child’s grade level (Fall 2017):___________________
Parent or Guardian Name (s):____________________________________
Parent or Guardian preferred number:__________________________
Parent or Guardian secondary number:_________________________
Email address:____________________________________________________
VBS T-Shirt Size: YS, YM, YL, AS, AM, AL, AXL (circle one)
There is a request of $5 to cover your child’s t-shirt. 
Allergies or other medical conditions:_______________________________________________
In case of emergency, contact:_____________________________________________________
Phone (s):_________________________________________________
Relationship to Child:_______________________________________
______I give permission to have photographs taken of my child.
______I give permission to have photographs of my child posted to the church website or bulletin.
Parent Signature:__________________________________________  Date:_______________________