kids

VBS Registration form 2010
Families, please complete one form per child. Thank you
(note some fields must be filled)

Child’s name*

First

Last

Birthdate

YYYY

Age

Gender*

Child’s Grade (Fall 2010)

Child’s Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Parent’s/Guardian’s Name*

First

Last

Parent’s/Guardian’s Email*

Parent’s/Guardian’s Phone*

###

####

Second option

###

####

Persons to be contacted in case of emergency:*

First

Last

Phone Number*

###

####

Name

First

Last

Phone Number

###

####

Does your child have any medical condition(s) that
we should be aware of?*

(allergies, medications, etc.) If so, please
explain:*

I would like to volunteer to help with:

Crafts

Games

Snacks

Being a group leader

By checking this box you agree that any
photographs taken of your child at or during this
event are the property of The Main Place Christian
Fellowship and may be used in future publications
as deemed appropriate.*

Check

Specials instructions

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