Each One, Reach One
Home

VBS Registration:

Parent / Guardian Information:

Child Information:

* First Name:
* Last Name:
* Phone:
* Birthday:
* Age:
* Grade Just Completed:
Address:
City:
State:
Zip:
* Gender
Note: Nursery through 4 Year old classes available only for those volunteering at VBS
* First Name:
* Last Name:
* Home Phone:
* Work / Cell Phone:
* Email:
Address:
City:
State:
Zip:
Home Church
Are you volunteering at VBS? Where?

Emergency & Medical Information:

* Full Name:
* Who to contact in the event of an emergency:
* Phone:
* Allergies or other health concerns:

Special Requests:

Special Requests: (Such as a friend you would like to be in your childs class)
* The following people are authorized to drop off and pick up my child:
Outrigger Island at Hopewell Baptist Church
Surfer
(Must be 5 by 9/1/08)