VBS 2011 June 13-17
Name Age Van rider? Yes No
Grade just completed Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade
Other family members attending VBS
Parent/Guardian What church do you attend?
Street
City State Zip Code
Home phone Cell phone
Allergies? Yes No If so, what is your child allergic to?
Other Medical information?
Special Instructions?
Family Night, June 17, we will be doing a slide presentation.
Do we have your permission to photograph your child during the week? Yes No
