Parent/Guardian Information

Your Name

Your Address

Your Email

Your Telephone Number

Do you have a church home? If so, where?


Child's Information

Child's Name

Age         D.O.B.    

Last grade completed
 Boy Girl

Has your child attended VBS at Joshua's Place before?
 Yes No

Does your child have any food allergies?
 Yes No

Does your child have any special needs?
 Yes No

If so please list them below


Emergency Contacts

Please keep in mind that only people listed as emergency contacts may pick up your child from VBS.

Emergency Contact Information (One is required)
Contact Name:
Relationship to Child:
Contact Phone Number:

Contact Name:
Relationship to Child:
Contact Phone Number: