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Vacation Bible School Registration
Child's Name
Age
Date of Birth
Grade and School in the fall
Parent/Guardian's Name
Home Address
Home Phone Number
Cell Phone Number
Email Address
Name, address and phone number of an emergency contact person
Please indicate any medical concerns your child may have such as allergies or any other information you feel we should know about your child.
Do you give the United Church of Shirley permission to use photos of your child for use on our website, newspapersor any other potential media or publictions?	Yes No
Is the Parent/Guardian a church member?	Yes No
Can you volunteer to help? If so in what capacity?