2010 VBS Registration Form

*** PLEASE PRINT ***

Child’s Name_______________________________________________________________________
(list additional children’s names on back of sheet)

Parent/Guardian Name_______________________________________________________________

Address______________________________________________________ Zip Code_____________

Mailing Address (if different)__________________________________________________________

Phone Numbers

Home________________________ Work_______________________ Cell_______________________

Email______________________________________________________________________________

Child’s Age______________

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

Emergency Contacts

Name________________________________________ Phone Number_________________________

Name________________________________________ Phone Number_________________________

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

Other Information
Do you attend Sunday School? If so where?

If you are visiting our church, who are you a guest of?

May we have permission to photograph your child? Yes No

May we have permission to use your child’s photograph for the purpose of promotion? Yes No

*** SEE REVERSE SIDE ***

IF MORE THAN ONE CHILD IN YOUR FAMILY IS REGISTERING
PLEASE INCLUDE THEM BELOW.

Child’s Name_______________________________________________________________________

Child’s Age_______________

Medical Information__________________________________________________________________

Child’s Name_______________________________________________________________________

Child’s Age_______________

Medical Information__________________________________________________________________

Child’s Name_______________________________________________________________________

Child’s Age_______________

Medical Information__________________________________________________________________

Child’s Name_______________________________________________________________________

Child’s Age_______________

Medical Information__________________________________________________________________

Child’s Name_______________________________________________________________________

Child’s Age_______________

Medical Information__________________________________________________________________

Child’s Name_______________________________________________________________________

Child’s Age_______________

Medical Information__________________________________________________________________

St. Paul’s Bible Church 1960 W. 94th Street Chicago, IL 60643 773-238-4368