CROSBY CHURCH KIDS VBS REGISTRATION

One Form per Child Please

Child's First Name

Child's Last Name

Grade Completed:

Birthday

Age:

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Home Phone

Alternate Phone

Allergies

Medical/Behavior concerns:

Fmaily Doctor

Doctors Phone

Please list names and ages of siblings attending VBS

Church Affiliation:

Church Membership at:

Please list person(s) name(s) and phone number(s) who may pick up your child.

Vacation Bible School (VBS) leaders have permission to photograph / film the minor designated above for any lawful purpose associated with this VBS program.

Parent Signature

Date Input