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June 8-12 from 6 - 9 p.m.
Please fill in all fields marked with a *
	Child's Name	*
	Guardian / Parent	*
	Address	*
	Mailing Address
	Home Phone (xxx-xxx-xxxx)
	Cell Phone (xxx-xxx-xxxx)	*
	Work Phone (xxx-xxx-xxxx)
	e-Mail	*
	Birthdate (xx/xx/xx) must be atleast 4 yrs old	*
	Last Grade Completed
	Medical Information: Please list medical or other information we need to know including any food allergies.	*
	Emergency Contact (name and phone #)	*
	Who will pick up your child at the end of each VBS day?	*
	Do you go to another church?	yes	no
	If so, which church?
	Can we photograph your child?	yes	no*
	Can we use the photograph for the final day slideshow?	yes	no *