Mother's Name

Father's Name

AddressPhone #

City State Zip 

Emergency Contact Name & Phone

Church Member-Yes No

Child's Name Age

Grade Completed     

T-Shirt size: Youth-S M L  Adult-S M L

Child's Name Age
Grade Completed 

T-Shirt size: Youth-S M L  Adult-S M L

Child's Name Age
Grade Completed

T-Shirt size: Youth-S M L  Adult-S M L

I give permission for pictures of my child/ren to be used in publicity of future Vacation Bible Schools,
print media, web site and video presentations.

Parent Signature _________________________________________

Please complete, print out, and drop off or mail to church.