VBS Registration Form

Church now attending:_________________________________________________________________Child’s name: _____________________________________ Last school grade completed: ___________Child’s birth date: ____________ Allergies/medications: __________________________________________________________________________________________________________________________Home address: _______________________________________________________________________Mother’s name: _____________________________________ Work phone: ______________________Mother’s occupation: _________________________________ Cell phone: _______________________Mother’s address/home phone (if different): ___________________________________________________________________________________________________________________________________Father’s name: ______________________________________ Work phone: ______________________Father’s occupation: __________________________________ Cell phone: _______________________Father’s address/home number (if different): ___________________________________________________________________________________________________________________________________Crew name (Church use only:)_________________________________VBS Registration Form(please fill out ONE per child)June 18 – 22, 2012Date: _________________________Home phone number: _________________________T-shirts are $5.00 per person.Please see attached T-shirt order form.Form continued on back side

Additional persons to call in an emergency & authorized to take child from facilityInclude persons picking up child daily (except parents)******************************************************************************Name Relationship Phone______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________EMERGENCY CONTACT PERSON OUTSIDE SOUTHERN CALIFORNIA AND PHONE NUMBER:_______________________________________________________________________________Please order T-shirts on attached form.

T-shirt Order Form(One per child)VBS T-shirts are available for $5.00/person.* Please indicate shirt size below:Child's Name__________________________________________________________________Shirt Size:Youth SmallYouth MediumYouth LargeYouth Extra LargeAdult SmallAdult Medium*You MUST pay $5.00 when turning in this formor your child’s shirt will not be reservedOFFICE ONLYPaid _________