VBS Registration

Child's Name

Child's Birth Date

Completed School Grade

Parent/Guardian Name

Cell Phone

Address

Emergency Contact

Phone for Emergency Contact

Relationship to Child

Allergies/Medical Information: allergies, dietary needs, medications?

I agree to bring all medication to Day Camp Director in original containers.

I give my permission for my child to participate in Zion Evangelical & Reformed Church's VBS. I will not hold them responsible.

How did you hear about Zion's VBS?

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