Child's First Name
Child's Last Name
Child's Age
Child's Birthday (MM/DD/YY)
Grade entering in fall 2011
Food Allergies? no
yes Details:
Medical Needs? no
yes Details:
Siblings Attending VBS? no
yes Names and ages:
(Please be sure to register siblings with separate forms.)
Parent/Guardian
Information
Do you give permission for your child's picture to be used in
VBS promotional materials and the Hillcrest Church website?
By chosing "yes" your child's picture may be viewed on www.hillcrestumc.com
on the VBS web page during VBS week.
yes no
Your First Name
Your Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
Cell Phone
E-mail
For your child's
safety he/she will only be released to you or those who you list below.
Please provide the
first and last name of those pick up your child:
Pick Up 1:
Pick Up 2:
Emergency Contact
Information
Name
Relationship to Child
Home Phone
Alternate Phone
Anything special
you want us to know about your child?
Please be sure to
review your information before submitting.
Selecting the
"Submit Form" button below is the equivalent of your signature.