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Child's Name: |
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Parent or Guardian's
Name:
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Address:
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Phone: |
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Home Number: |
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Work Number: |
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Cell Number: |
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Email: |
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Age Information:
Date of Birth: |
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Grade Completed: |
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Medical Information
Medical or other information
we need to know (Please include any information about
allergies):
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Emergency Contact
Information
Name: |
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Phone: |
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Name: |
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Phone: |
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Dismissal Information:
Who may pick up your child at the end of each VBS Day?
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Other Information:
Do you attend church? If so, where?
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If you are visiting our
church, who are you a guest of? |
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May we have permission to
photograph your child?
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May we have permission to
use your child's photograph in church publications for
the purpose of promotion?
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T-Shirt orders must be
prepaid. Cost is $10.00. Make Checks payable
to MZBC.
TShirt Size
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