Vacation Bible School Student Registration

Child's Name

Gender Gender Boy Girl

Child's Birthdate

School Grade Entering Fall 2018 (Colors after each grade are the T-shirt colors.) School Grade Entering Fall 2018 (Colors after each grade are the T-shirt colors.) Pre-K (orange) Kindergarten (green) Grade 1 (girls yellow, boys royal blue) Grade 2 (girls yellow, boys royal blue) Grade 3 (girls purple, boys navy blue) Grade 4 (girls pink, boys red) Grade 5 (girls pink, boys red)

Parent(s) Name

Street Address

City

State

ZIP

Email Address

Emergency Contact Number

Permission to use child's image on website or newsletter? Permission to use child's image on website or newsletter? Yes No

Permission for child to participate in water activities? Permission for child to participate in water activities? Yes No

Child's Allergies or Other Medical Conditions (or enter 'None')

Home Church (or 'None')

I certify that I am the child's parent/guardian and that I completed this form. I certify that I am the child's parent/guardian and that I completed this form. Yes No

Number