St. Paul’s Vacation Bible School
June 24-28-2019
Registration Form

Child 1 Name *
Child 1 Name
As of June 24, 2019
Child 1 Date of Birth *
Child 1 Date of Birth
As of June 24, 2019
Child 2 Name
Child 2 Name
Child 2 Date of Birth
Child 2 Date of Birth
As of June 24, 2019
Child 3 Name
Child 3 Name
As of June 24, 2019
Child 3 Date of Birth
Child 3 Date of Birth
Child 4 Name
Child 4 Name
As of June 24, 2019
Child 4 Date of Birth
Child 4 Date of Birth
Child 5 Name
Child 5 Name
As of June 24, 2019
Child 5 Date of Birth
Child 5 Date of Birth
Parent or Guarding Information and Releases
List Child(s) Name and any Allergies/Medical Information/Other Important Information you wish us to know.
Photo Release *
I give my permission for the children listed on the reverse to be photographed/videotaped while attending Vacation Bible School at St. Paul’s Presbyterian Church, understanding that such visual images will become the property of St. Paul’s Presbyterian Church and may be used for public relations or publicity.
Travel Permission *
Permission to leave church grounds during VBS: I give my permission for the children listed on the reverse to walk in the local neighborhood for recreation, service or craft activities during the week of VBS with adult supervision.
Name Of Parent Or Guardian *
Name Of Parent Or Guardian
Parent or Guardian Address *
Parent or Guardian Address
Main Phone *
Main Phone
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Emergency Contact 1 Name *
Emergency Contact 1 Name
Emergency Contact 1 Phone *
Emergency Contact 1 Phone
Emergency Contact 2 Name
Emergency Contact 2 Name
Emergency Contact 2 Phone
Emergency Contact 2 Phone
Names of person(s) who may pick up the children listed above from VBS.
Date *
Date
By submitting this form you are creating an electronic signature for this event.