2018 VBS REGISTRATION Peace Presbyterian

VBS REGISTRATION FORM

Peace Presbyterian Church

3203 Ramsey Street, Fayetteville, NC 28301 sctypeacepcusa@embarqmail.com (910) 488-3211

You may register up to 3 children from same family per submission. Please submit registration and start a new one if you want to register additional children from your family.

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* 1. Child #1 Info

Child's Name

Child's birthday (m/d/yr)

Last grade child completed

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* 2. Child #1 Medical Concerns

Allergies?

Diet or other restrictions?

other conditions to be aware of

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* 3. Child #2 Info

Child's Name

Child's birthday (m/d/yr)

Last grade child completed

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* 4. Child #2 Medical Concerns

Allergies?

Diet or other restrictions?

other conditions to be aware of

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* 5. Child #3 Info

Child's Name

Child's birthday (m/d/yr)

Last grade child completed

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* 6. Child #3 Medical Concerns

Allergies?

Diet or other restrictions?

other conditions to be aware of

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* 7. Address

Parent/Guardian Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 8. Please tell us who we should expect to drop off and pick up your child(ren). In the case of an emergency, we will contact the above number and then move to the phone numbers you list below if necessary.

Name of person typically transporting child and phone number

Name of another person who may child and phone number

Any other people or situations we should know about regarding pickup/drop off?

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* 9. Volunteering Info

Name of Volunteer

grade or age (if volunteering your time)

Church you are affiliated with and phone number (if volunteering your time)

I can help with VBS on these days

I can help with craft or food supplies

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* 1. Child #1 Info

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* 2. Child #1 Medical Concerns

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* 3. Child #2 Info

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* 4. Child #2 Medical Concerns

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* 5. Child #3 Info

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* 6. Child #3 Medical Concerns

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* 7. Address

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* 8. Please tell us who we should expect to drop off and pick up your child(ren). In the case of an emergency, we will contact the above number and then move to the phone numbers you list below if necessary.

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* 9. Volunteering Info

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* 10. Anything else we should know?