Vacation Bible School

Registration Form

Child’s Name_________________________________________

Parent/Guardian Name__________________________________

Address_____________________________________________

Email Address________________________________________

Phone Numbers  Home________Cell_______Work_________

Age Information:

Date of Birth_________________Age_____________

School grade completed this year____________

Home Church______________________________

Allergies/Medical Information/Other:

____________________________________________________________________

Emergency Contacts:

Name______________________________________Phone_______________

Name______________________________________Phone_______________

Dismissal Information:

Name(s) of person(s) who may pick up this child form VBS

__________________________________________________________

Other Information (church use only):

Surfer Group___________________________________

Are parents helping with VBS? ________

Note:  Please print and return to the parish office or drop form in the collection at Mass.