VBS Pre-Registration

• FILL OUT A NEW FORM FOR EACH CHILD ATTENDING
• Child's Last Name*
• Child's First Name*
• Child's Gender*
  >MaleFemale
• Child's Birth Date*
  MM

  /

  DD

  /

  YYYY
• Age As Of July 31st, 2010*
• Grade Completed June, 2010*
• Parent Name (s)*
• Your Email*
   
• Cell Phone*
   
• Home Phone*
   
• Address*
  Please include street address, city, and zip code.
• Please List Any Allergies Or Medical Conditions*
• Will your child be walking TO VBS without an adult?*
  PARENTS ARE REQUIRED TO CHECK THEIR CHILD IN ON THEIR FIRST NIGHT ATTENDING
  Yes

  No
• Will your child be walking HOME without an adult?*
  Yes

  No
• Does your child have any siblings attending VBS with them?*
  >YesNo
• Names and Grades of any siblings attending VBS with them*
• Will these siblings be walking home together?*
  Yes

  No
• Authorized Pickup #1*
  This person will be authorized to pick-up your child from VBS
• Authorized Pickup #2*
  This person will be authorized to pick-up your child from VBS
• Emergency Contact Person*
  First Name

  Last Name
• Emergency Contact Phone Number*
   
• Do You Attend Church On A Regular Basis?*
  >YesNo
• If Yes, Where?
• Has This Child Attended VBS with Church at Riverside In The Past?*
  Yes

  No
• May We Have Permission To Photograph Your Child?
  Yes

  No
• May We Have Permission To Use Your Child's Photograph In Church Publications?
  Yes

  No
• Do you have any concerns that you would like the Pastor to contact you about?
• SECURITY CODE
  For Office Use Only