VBSChildRegistration - FPC Reading, PA

FPC Reading, PA

Presbyterian Church USA

VBS VOLUNTEER REGISTRATION
Please fill out the information below to sign up to help with VBS 2011

VBS CHILD REGISTRATION
Please fill out the information below to register your child for VBS 2011. If you have more than one child who will be attending, please fill out this form separately for each child.

VBS 2011 Child Registration

Child's Name:
Parent/Guardian Name:

CONTACT INFORMATION
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:

AGE INFORMATION
Birth Date (MM/DD/YYYY):
Last Grade Completed in School:	Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

EMERGENCY CONTACTS
Please list two individuals and their phone numbers who may be contacted in an emergency.
Name #1:
Phone #1:
Name #2:
Phone #2:

MEDICAL INFORMATION
Please list and medical or other information we need to know. (Please include any food allergies.)


DISMISSAL INFORMATION
Who may pick up your child at the end of each VBS day?

ADDITIONAL INFORMATION
May we have permission to photograph your child?	Yes No

Please use this space for any additional comments or questions: