Without Walls Church - Vacation Bible School Registration

Vacation Bible School Registration

Child's Name

First Name

Last Name

Grade Child Completed

Birthdate

Parent's Name

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Home Phone Number

Cell Number

Emergency Contact Person:

First Name

Last Name

Relationship to child:

Food Allergies please list

Medical Concerns - If yes, explain

Siblings Attending VBS (Names and Ages)

First Name

Last Name

Birthdate

First Name

Last Name

Birthdate

First Name

Last Name

Birthdate

Person(s): Who May Pick up the Child:

First Name

Last Name

Phone Number

First Name

Last Name

Phone Number

T-Shirt Size(s) Price $8.00