VBS Registration Form

2014 VBS Registration

(fill in every field)

Note: As soon as we receive your registration, we will send a confirmation email to the address below. If you have not received a confirmation email within 2 business days (Monday -Thursday), please contact the church office.

Child's Name:

Parent/Guardian Name:

Address:

Phone Numbers:

Home:

Work:

Cell:

Email Address:

Birthday:

Last Grade Completed:

Medical Information

Medical Info./Conditions (include allergies, etc.)

Emergency Contacts (if different than above)

Name:

Phone:

Relationship to child:

Dismissal Information:

List Names of those approved to pick up your child (other than the above):

Person 1:

Person 2:

Person 3:

Church your family attends:

If invited to attend by

someone at CBC, who:

Child's T-Shirt Size:

Youth X Small

Youth Small

Youth Medium

Youth Large

Adult Medium

Adult Large

Adult X Large

We will be taking pictures & video throughout the week. May we use your child's photo?

Yes
No

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