VBS 2016 Registration

VBS Registration 2016

Child(ren) Attending *

Additional *

Parent/Guardian Names *

Additional *

Date of Birth(s) *

Additional *

Age(s) *

Additional *

Last School Grade Attended *

Additional *

Email *

Home Church *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Work Phone *

Allergies/Medical Information/Other: *

Emergency Contact 1 *

First

Last

Phone Number *

Emergency Contact 2 *

First

Last

Phone Number *

Dismissal Information: Name(s) of person(s) who may pick this child from Rehoboth VBS *

T-shirt size(s): *

NOTE: Photographs/videos will be taken during the week of VBS, and these pictures will be used in church services. Please sign below to acknowledge that your child may be photographed. *

Yes, I agree No, I do not agree

Printing Name Below Acts as Signature and Authorization of Form *

First

Last

Submit

If you wish to fill out a hard copy and hand it in to the church office in person please download the file below

vbs_registration_form_2016.pdf
File Size:	303 kb
File Type:	pdf

Download File

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