Click Here for Printable Form
Last Name
Child's Name
Grade Entering
Boy
/ Girl
Child's Name
Grade Entering
Boy
/ Girl
Child's Name
Grade Entering
Boy
/ Girl
Address
City
State
Zip
Phone
Cell
Child(ren)’s School Name
K5 and under for volunteer's children only.
VBS workers only:
Nursery (Infant-2yrs. Old)
By Sept 1.
K3
K4
K5
Parent/Guardian Names:
Church you attend
Are you a member?
Yes/
No
Allergies/Health Problems
Other Comments
Pediatrician
Chart#
Phone
In Case of Emergency List “2” Contacts other than yourself:
Name
Phone
Relation
Name
Phone
Relation
For VBS Volunteers ONLY
I am a VBS Volunteer. I will be working with
area/gr at VBS.
If I cannot be reached in case of an emergency, I give Evangel VBS permission to seek medical treatment for my child. I also understand that I will be in the pick up line for the children no later than 12:15pm.
Email Address (required)
2/5/2012
By submitting this form, you are agreeing to the above stated terms.
******To be Pre-registered this form must be received by 7/5/11*****
*****Note: This form must be completely filled out for all ages! *****
In case of rain: play and snack will be held in the gym. Children will be taken by church van and certified driver across the church parking lot.