* Child's name (first & last)

* Child's age

* Name(s) of parent(s)

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

* Parent's preferred phone #

* Name of emergency contact

* Emergency contact's phone #

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

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

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

* 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.)

T