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* Child's name (first & last)

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* Child's age

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* Name(s) of parent(s)

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* Parent's address (street, city, state, ZIP)

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* Parent's preferred phone #

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* Name of emergency contact

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* Emergency contact's phone #

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* Does your child have any food allergies or medical needs? Please list.

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* Is it OK for your child to be photographed at our VBS?

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* Who has your permission to pick up your child? Please list names.

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* I understand that I must sign a permission form the first time I bring my child to VBS. (Please arrive early on the first day to allow time for signing prior to the 10 am start time.)

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