Name (One child per form please) *
Name (One child per form please)
Birthday (mm/dd/yyyy) *
Birthday (mm/dd/yyyy)
Street, City, State, Zip Code
Phone *
Phone
Food Allergies *
Medical Concerns *
Vacation Bible School (VBS) leaders have permission to photograph/film the minor(s) designated above for any lawful purpose associated with this VBS program. *
Date
Date