VBS 2025

"Escape from Egypt"

Child First Name:

Child Last Name:

Full Birthdate:

Sex:

Grade (Just completed):

Address:

My child would like to be in the same group as:

Food Allergies/Medical Concerns:

Home Church:

Parent/Guardian First Name:

Parent/Guardian Last Name:

Home/Cell Phone:

Work Phone:

Email:

Emergency Contact First Name:

Emergency Contact Last Name:

Emergency Contact Relationship:

Emergency Contact Phone Number:

Permission to go to the park across the street off church grounds:

Permission to post pictures on social media, church app, and/or church website (names not mentioned):

Questions/Concerns: