Vacation Bible School Registration

Child(ren) Information
First & Last Name Birthdate School grade this fall
Parent/Guardian Name
First Last
Address
Street Address Address Line 2 City ZIP Code
Email
Phone
If you have a home church, please include
Allergies or medical information
Emergency Contact Name
First Last
Emergency Contact Phone
Name of person who may pick up your child from VBS; other than parent/guardian
First Last
Consent
I give permission to have my child photographed or filmed as participating in VBS program for any lawful purpose.
Group
Name of friend your child might like to be with in group. We'll try our best but not guaranteed.
How did you hear about our VBS program?
- Attend New Life
- Website
- Facebook
- Friends at New Life
- Community group that meets at New Life
- Other

First & Last Name	Birthdate	School grade this fall