VBS Registration

Register for Vacation Bible School 2018

June 4 - 8 • 9 a.m. - Noon • Ages 3 - Grade 5


Child's Name: Grade Complete: Age:

Child's Name: Grade Complete: Age:

Child's Name: Grade Complete: Age:

(Please note children must be age 3 by June 1 and toilet trained to attend)

Parents' names:

Home address: (Redeemer members please skip this question)

Primary phone: Alternate phone:

Email address (required):

Emergency contact person: Phone:

Relationship to child:

Food allergies: Please list and explain:

Medical or other concerns: Please list and explain:

Church affiliation: Church membership at:

Please list the adults who will be picking up children:

Days of Attendance:

VBS leaders have permission to photograph/film the minor(s) designated above in any manner or for any lawful purpose associated with this VBS program:

Please send me emails concerning future church events:

Parent's signature (check box in lieu of signature) (required): Signed