VBS form

Vacation Bible School Registration 2010

Home		West Side Church of Christ

Saturday July 24th 9am - 1:30 pm Age 3 years through 5th grade Register by Wed. 7/21/10

Parent or Guardian Name: *
1st Child Name: * First and Last Name
1st Child Age or Grade: * Example: Enter an Age as '4yr' or Enter Last Grade Completed as 'Grade 3'
2nd Child Name: First and Last Name
2nd Child Age or Grade: Example: Enter an Age as '4yr' or Enter Last Grade Completed as 'Grade 3'
3rd Child Name: First and Last Name
3rd Child Age or Grade: Example: Enter an Age as '4yr' or Enter Last Grade Completed as 'Grade 3'
4th Child Name: First and Last Name
4th Child Age or Grade: Example: Enter an Age as '4yr' or Enter Last Grade Completed as 'Grade 3'
5th Child Name: First and Last Name
5th Child Age or Grade: Example: Enter an Age as '4yr' or Enter Last Grade Completed as 'Grade 3'
Address: *
City: *
State: *
Zip Code: *
Home Phone: *
Cell Phone:
E-mail Address: * Enter E-mail if return confirmation is wanted and updates send.
Does any child have any food (dairy, peanut, etc.) allergy. *YesNo
If yes, please list: *
I hereby consent to our child(ern) participating in the West Side CofC VBS program *I disagreeI agree