Saint Andrew's VBS Registration Form 2019

Completed Registration is due by May 31.

Child's Name: Child's Name: First Last
Birth Date: Birth Date: / MM / DD YYYY
School grade for this coming fall
VBS T-Shirt size:

VBS T-Shirt size: Child XS Child S Child M Child L Adult S Adult M Adult L Adult XL
If your child has asthma or allergies that require an inhaler or EpiPen, please note and bring labeled medication and instructions to VBS leader.
Asthma:

Asthma: Yes No
Allergies:

Allergies: Yes No
If yes, please specify:
Any special concerns:
Parents'/Guardians' Name(s): Parents'/Guardians' Name(s): First Last
Parent/Guardian Address: Parent/Guardian Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian e-mail:
Parent/Guardian Phone - Daytime: Parent/Guardian Phone - Daytime: - ### - ### ####
Parent/Guardian Phone - Evening: Parent/Guardian Phone - Evening: - ### - ### ####
Parent/Guardian Phone - Other: Parent/Guardian Phone - Other: - ### - ### ####
Name of Emergency Contact Backup: Name of Emergency Contact Backup: First Last
Phone Number for Emergency Contact Backup: Phone Number for Emergency Contact Backup: - ### - ### ####
Do you give permission for us to take and print pictures of the registered child for VBS?

Do you give permission for us to take and print pictures of the registered child for VBS? Yes No