Greenlee Baptist Church

Child's Name

Parent/Guardian Name

Address / City / State / Zip Code

Contact Information

Home Number and/or Cell Number

Email

Age Information

Birthdate

Last grade completed in school

Medical Information

Medical or other information we need to know. Please include any food allergies.

Allergies

Emergency Contacts (other than listed above)

Name and Phone numbers

Dismissal Information

Who may pick up your child at the end of each VBS day?

Other Information

Which days will your child attend dinner? Please check all days that apply.

Monday 6/22

Tuesday 6/23

Wednesday 6/24

Thursday 6/25

Friday 6/26

Does your child attend church? If so, where?

If your child is visiting our church, who is he/she a guest of?

May we have permission to photograph your child?

Yes

No

May we have permission to use your child's photograph for promotional purposes?

Yes

No

Signature