REGISTRATION FORM Child #1 * First Name Last Name Date of Birth * MM DD YYYY T-shirt Size * Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Child #2 First Name Last Name Date of Birth MM DD YYYY T-shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Child #3 First Name Last Name Date of Birth MM DD YYYY T-shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Child #4 First Name Last Name Date of Birth MM DD YYYY T-shirt Size Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Parent/Gaurdian * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Gaurdian's Phone * (###) ### #### Gaurdian's Email * Medical Information * Medical or other information we need to know. (Please include any food allergies.) Emergency Contacts * Names & Phone Numbers (other than listed above) Dismissal Information * Who may pick up your child at the end of each VBS day? May we have permission to photograph your child? * Yes No Thank you!
