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Child REgistration Form
Mark your calendars for Vacation Bible School ! We'll meet at 1250 Beaumont Ave, in Beaumont from June 27th-June 30th; 5:30pm-8:00pm. See you soon!
Child's Information
First Name
Last Name
Age
1
2
3
4
5
6
7
8
9
10
11
12
Grade
Pre k/ Kinder
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Parent/Guardian Name
Phone Number
Email Address
Preferred Contact Method
Emergency Information
Emergency Contact 1
Phone Number
Emergency Contact 2
Phone Number
Doctor Name
Phone Number
Allergies or Special Needs
DISMISSAL: Who may pick up your child from VBS each day?
Name
Relationship
Name
Relationship
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Parent/Guardian Signature
Date
Relationship to Child
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