Vacation Bible School Registration Form

To register for Calvary's 2011 VBS Program, July 11-15, please complete the information below and click the "SUBMIT" button at the bottom of the form.  if you provide an e-mail address you will be sent a message acknowledging receipt of your form.

Child's Name:

Parent/Guardian Name:

Address:

E-Mail Address:

Phone Numbers:

    Home:     Cell:     Work:

Age Information:

    Date of Birth:      Age:

    Last school grade completed:

Home Church:

Allergies/Medical Information/Other:

Emergency Contacts:

    Name 1:     Phone1:

    Name 2:     Phone2:

Dismissal Information:
Name(s) of persons who may pick up this child from VBS each day:

Other Information (church use only):

Treasure Group:

Are parents helping with VBS?   (if yes,) Where?