VBS Student Registration Form Please submit one form for each child. After you submit one child, refresh the page to do another. Student's Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth: * Age * Gender Male Female Last School Grade Completed: * Parent's Email * Parent/Guardian Name: * Home Telephone: * Primary Contact Name & Number: * Emergency Contact Name(s) & Number(s): * Physical Restrictions (if none, put N/A): * Medical Conditions (i.e. allergies, asthma, etc) (if none, put N/A) * Instructions & Medications (if none, put N/A): * Date of last tetanus or booster: * I do not wish my/our child to participate in the following: Pickup Instructions: * Who is authorized to pick up your child? (Only authorized individuals with an ID will be allowed to pick up a child.) Information Provided by: * Thank you. Your forms have been received. On the first day of Vacation Bible School a parent/guardian need to be present to sign the Consent & Release form.We look forward to seeing you on July 14, at 6:30pm!
