VBS 2017
VBS 2017
List the names and AGES of ALL children being registered in the box below. There is an additional box if needed
Please LIST AGES of Children with names as well
Child’s name and AGE (list all)  * 
Additional name and age space if needed
Parent/Guardian Name  * 
Street Address  * 
City  * 
Zip Code  * 
Your Email Address  * 
Home Church (please type ’None’ if you currently do not have a home church)  * 
If your child has a special friend attending that they wish to be with, please list that child's name here.
Name of special friend
Please make sure you listed both your child’s name AND age in box above.
Payment Cost is $5 per child. Please choose the correct amount based on the number of children you are registering.  * 
Contact and Additional Information
Parent/Guardian Name AND Best Contact Number  * 
Emergency Contact Name AND Best Contact Number  * 
If you wish for someone other than you (parent/guardian) to pick up your child(ren) you MUST complete the box below.
If left blank no one other than parent/guardian will be allowed to pick up child(ren). This restriction includes older siblings as well, so please add them below if authorized .
Authorized to pick up child(ren) and Best Contact Number
Allergies and Medical Information (Please type ’None’ if not applicable) * 
ALL parents/guardians are required to come in on the first day their child(ren) come to VBS to complete and sign a Medical information card.
This will include insurance and physician information so please make sure you bring that information along with you.
Please note that for your child’s safety, they will not be allowed to participate without a signed VBS medical form on file. Thank You.
I understand that I must have a signed medical form on file in order for my child to participate in VBS. (Please type in ’Yes’ after reading above information)  * 
Thank you for your registration. We look forward to seeing you and you child(ren) on Monday, June 19 at 9am. You may come to fill out your medical forms beginning at 8:00am.
If you have any questions please contact Lisa Musick or Deacon Jennifer Scherzer at 281 255-4111
Total $
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