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Child's Name
Parent/Guardian Name
Address
Phone Numbers: Home Work Cell E-mail:
AGE INFORMATION:
Birthdate MM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 For school-age students, last grade completed Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade
MEDICAL INFORMATION: Medical or other information we need to know. (Please include any food allergies.)
EMERGENCY CONTACT:
Name Phone Number
DISMISSAL INFORMATION: Who may pick up your child at the end of each VBS day?
OTHER INFORMATION: Do you attend Sunday School? Yes No
If yes, where?
If you are visiting our church, who are you a guest of?
May we have permission to photograph your child? Yes No
May we have permission to use your child's photograph in church publications for the purpose of promotion? Yes No