| I am registering for: |
VBS 2009 |
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Please fill out a separate form for each child. |
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Child's First Name |
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| Child's Last Name |
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| Entering Grade |
in FALL 2009 |
| Gender |
M F |
| Birthdate |
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Address 1 |
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| Address 2 |
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City |
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State |
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Zip |
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Parent(s) Name |
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| Home/Work Phone |
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Cell Phone |
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| Email |
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Emergency Name
(just in case!) |
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| Emergency Phone |
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| Brought by |
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Church you are
currently attending |
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If you do not attend
Berean, how did
you hear about VBS? |
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Medical/Other Info we
need to know (i.e. food
allergies, medications,
pre-existing health
problems, etc.) |
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Who may pick up your
child at the end of each
VBS day? |
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