Child's Full Name	Age
Address
City
Zip
Home Phone

Parent's Name:   Cell #: Evening #:
Parent's Name:   Cell #: Evening #:

Please list another adult to be contacted in case of an emergency if parents cannot be reached.

Adult's Name:   Cell #: Evening #:

Does your child have any food allergies? No () Yes ()  Please list:

 Does your child have any medical conditions that would keep him/her from participating in any activities?
No () Yes ()  Please list:

Do you have a church home?
No () Yes ()  If so, what is the name of your church? 

How did you hear of our VBS?

Please check your T-shirt size:
 Every effort will be made to give each child a shirt.
 However, we cannot guarantee availability of sizes and shirts for children who register after June 29.)  

----------------Youth Sizes --------------         -------  Adult Sizes ------------------

  2/4T         6/8            10/12          14/16           34/36               38/40               42/44 

 y-xsm       y-sm            y-med        y-lg            a-sm                a-med                a-lg
                                                                                            

 Free shirts for the children.  Adult shirts $10.00