How many children are you registering?
12345

Child's Name *

Parent/Guardian Name *

Address *

City/State/Zip *

Phone Numbers:
Home

Work

Cell

Email Address *

Age Information:
Last grade completed in school (or Date of Birth of Preschoolers - must be 5 years old by August 31, 2018) *:

Medical information and other information we need to know (Please include any food allergies):

Emergency Contact:
Contact Name 1 *

Phone Number 1 *

Emergency Contact:
Contact Name 2

Phone Number 2

Dismissal Information:
Who may pick up your child at the end of each VBS day? *

Phone Number: *

Other Information:
Do you attend church anywhere?
---YesNo

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

May we have permission to photograph your child for VBS purposes? *
---YesNo

IMPORTANT FIELD TRIP INFORMATION:

What: Field trip to the Lazy 5 Ranch
When: Friday, June 28th
Time: Departure: 9:30 AM; Touring the park: 10:15 AM; Returning to the church by 12:15 PM.
Cost: FREE for the children; $10 (group rate) for adults.
Other Information: As a part of this trip, we need your permission to allow your children to go on the field trip. Adult chaperones and drivers are needed. We would love for parents to go with us, and they will need to drive their own vehicle. Parents can drive their own children, along with any other relatives (with written permission).

There will be 2 vans available for children ages 7 and up. Anyone requiring a car seat must be taken in a car with an adult.

If your child is not going, we must know by Wednesday, June 26.

PERMISSION INFORMATION:
The above child(ren) have permission to go on the field trip
YesNo

* required