VBS 2012 Registration
First Christian Church
Family Information
Father's Name:
Father's Home Phone:
Father's Cell Phone:
Mother's Name:
Mother's Home Phone:
Mother's Cell Phone:
Address 1:
Address 2:
City:
State:
Zip:
E-mail Address:
Do you have a Church Home?:
Yes
No
Name of Church Home:
Siblings NOT Attending
(For planning purposes, please enter the names and ages of siblings NOT attending VBS this year.)
Where did you hear about VBS?
Choose one
Newspaper
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Church Bulletin
Friend (include name)
School or club (include name)
Website
Previous VBS
Other (include below)
(Name of friend, club, other information)
Child Information
Child's First Name:
Child's Last Name:
Birthday:
month
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January
February
March
April
May
June
July
August
September
October
November
December
day
------
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year
------
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Grade (last completed):
Choose one
B-3yrs
4yrs
PreK
K
1
2
3
4
5
6
Primary Spoken Language:
School:
Medical/physical information
(Please state any conditions or limitations of a medical nature which might impact your child's participation in Vacation Bible School. Enter "None", if none apply.)
Other comments
(Allergies to bee stings, aspirin, penicillin, foods; Medications regularly taken. Enter "None", if none apply.)