VBS REGISTRATION
June 15th-19th, 9am to noon
Ages: 4 years to rising 6th grade
Please fill out one registration per child
Name __________________________________________________________________________
Address ________________________________________
City _____________________________ State ______________ zip ______________
Email Address:_______________________________________________
Do you prefer to get information by email? (circle one) YES NO
Birthdate ____________________
School grade/ preschool class as of August 25, 2009: ______________ __________
Parents Name _________________________________ Daytime phone __________________
Evening Phone Numb er:_____________________________
Doctor's name and phone number________________________________ ___________________
Person to contact in case of emergency______________________
Phone number:________________________relationship ________________________
alternative contact:_______________________________ phone number:__________________________________
List name of persons who may pick up this child from VBS each day:
_______________________________ ______________________________
Allergies or medical problems: _________________________________________________________________
Name of friend your child would like to be placed with (if applicable):__________________________________
Siblings attending VBS:_____________________________ ______________________________________
I would like to purchase: t-shirt@ $4 ___________ size sm med lg
Music CD @ $7 _________
There is a registration charge of $5 per child for VBS. We also encourage that your child participate in our mission project. You will receive further information about our project before the first day. You can also support VBS by helping with:
________ Set up before opening day ________ Work in the teacher's nursery
________ Send in items for snack
________ volunteer for VBS (circle one) All Days Partial Time
Preferred position________________________ Days Available ________________
