2017 VBS Child Registration Form

Anchor Baptist Church Vacation Bible School 2017

June 12-16. 9:00-12:00

Pre-K through 5th Grade. (Children must be 4 years old by January 31, 2017)

Childs Name *

Parent/Guardian Name *

Address

(street address, city, state, and zip code)

Mailing Address (if different)

Home Phone

Work Phone

Cell Phone

Birth Date

Month

Day

Year

Last grade completed in school

Medical or other information we need to know. (Please include any food allergies.)

Emergency Contact 1 Name

Emergency Contact 1 Phone

Emergency Contact 2 Name

Emergency Contact 2 Phone

Who may pick up your child at the end of each VBS day?

Does your child attend Sunday School? If so where?

If your child is visiting our church, who is he a guest of?

May we have permission to photograph your child?

Yes

May we have permission to use your child‚Äôs photograph for the purpose of promotion?

Yes

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