Almont Vineyard Church - VBS Registration 2022

First Name

Last Name

Email

Child #1 First Name

Child #1 Last Name

Child #1 Birthdate

Child #1 Please list any allergies, medical, or special needs

What grade has child #1 completed prior to the start of VBS?

Child #2 First Name

Child #2 Last Name

Child #2 Birthdate

Child #2 Please list any allergies, medical, or special needs

What grade has child #2 completed prior to the start of VBS?

Child #3 First Name

Child #3 Last Name

Child #3 Birthdate

Child #3 Please list any allergies, medical, or special needs

What grade has child #3 completed prior to the start of VBS?

Child #4 First Name

Child #4 Last Name

Child #4 Birthdate

Child #4 Please list any allergies, medical, or special needs

What grade has child #4 completed prior to the start of VBS?

Parent/Guardian's First Name

Parent/Guardian's Last Name

Phone Number

Email Address

Parent/Guardian's First Name

Parent/Guardian's Last Name

Phone Number

Email Address

Emergency Contact's First Name (if different from parent)

Emergency Contact's Last Name (if different from parent)

Phone Number

Email Address

Individual authorized to pick up my child's First Name

Individual authorized to pick up my child's Last Name

Relationship to Child

Individual authorized to pick up my child's First Name

Individual authorized to pick up my child's Last Name

Relationship to Child

Any additional comments or concerns

July 17-21 6:00-8:30PM