VBS Registration Please use this form to register each of your children to participate in this year’s VBS. Submit one form for each of your children. Company Child's Full Name * Child's Date of Birth * Gender * Female Male Last Grade Completed * 12 11 10 9 8 7 6 5 4 3 2 1 Kindergarten Pre-School Medical Info, Allergies and/or Special Need Physical Address * City * State * AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code * Child's Home Phone Child's Cell Phone Parent/Guardian Name * Parent/Guardian Home Phone Parent/Guardian Cell Phone * Parent/Guardian Email * Parent/Guardian Other Contact Info Add any other ways we might need to know if we have to contact you Emergency Contact Name & Phone Emergency contact name & phone number Persons Authorized to Pickup * List of authorized persons who can pickup child Are you a member of this church? * Yes No Magalia Pines Baptist Church How did you hear about our VBS? Word of mouth, a person, website? Let us know. Permission to photograph? * Yes No May we have permission to photograph your child? Photo release? * Yes No May we have permission to use your child's photograph in church publications?