Children's Ministry

Vacation Bible School - June 7-11, 2010

Child's Name Age

Parent or Guardian's Name Completed Grade

Address

Mailing Address If Different

Home Phone Number

Cell Phone Number

Work Phone Number

Email Address

Medical Information

(Please include any medical information that may be needed for your child.

Please include food allergies.)

Dismissal Information

(Please List the names of those who may pick up your child.)

Other Information

(Do you attend Sunday School? If yes, where?)

If you are visiting our church, who are you a guest of?

May we have permission to photograph your child? Yes No

May we have permission to use your child's photograph

for the purpose of promotion? Yes No