Vacation Bible School Registration Form - Pleasant View Community Church

Child's Name *

First

Last

Parent/Guardian Name *

First

Last

Contact Information

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Physical address same as mailing address? *

Yes
No

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Best Phone Number *

Email *

Age Information

Child's Birth Day *

Age at start of VBS? *

Last grade completed in school: *

Medical Information

Medical or other information we need to know. (Please include any food allergies.)

Emergency Contacts (other than list above)

Name

First

Last

Phone

Would you like to add another emergency contact?

Yes
No

Name

First

Last

Phone

Dismissal Information

Who may pick up your child at the end of each VBS day? (Please list first and last name of each person) *

Other Information

May we have permission to photograph your child? *

Yes
No

May we have permission to use your child's photo(s) for the purpose of promotion? (Flyers, brochures, social media posts, etc.) *

Yes
No

Parent/Guardian Signature *

Clear Signature