2017 Gospel Tabernacle Vacation Bible School Registration

Sunday June 18th - Wednesday June 21st | Please fill out this form and click submit.

Child's Name

*

Date of Birth

*

Sex

*

Please select one option.

Male Female

Last Grade Completed

*

Please select all that apply.

K4 K5 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade

Parent or Guardian Information

Parent/Guardian Name

*

Address

*

Email address

This address will receive a confirmation email

Home phone number

*

Cell phone number

Will you need van transportation ?

*

Please select one option.

Yes No

Allergies/Medical Information Other:

Emergency Contact (Other than listed above)

Name

*

Cell Phone

*

Address

*

Person Responsible for Picking up Child at end of VBS

Name

*

Phone Number

*

Permissions

May we have permission to photograph your child?

*

Please select one option.

Yes No

May we have permission to use your child's photograph for the purpose of promotion?

*

Please select one option.

Yes No

Description

Sunday June 18th - Wednesday June 21st

Please fill out this form and click submit.

Please Fix the Following

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