Name:
 

Email Address:

Address:
City:   Zip:

Phone numbers:

Home:   Work or Cell:

Age: Entering Grade:

Emergency Contacts & phone numbers:

List the names of persons, other than parents,  who may pick up this child from VBS each day: 

Allergies/medical Information or other concerns:

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Meal Reservations
Please indicate how many member of your family will be joining us for dinner each evening

Sunday:
Monday:
Tuesday:
Wednesday:
Thursday:

Please Print Out the Hold Harmless Agreement
Fill out the agreement and either mail or bring to the church
You will receive a confirmation of your reservation by email.