VBS Sign Up Form [Will be redone for 2012]

Printing Instructions:  Select/highlight the form below, starting with the first line "Registration Form..."  then go to your "File" and "Print" tabs, then check to print "Selection."

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Registration Form Vacation Bible School, July___ 2012, 9 a.m. - Noon 

DuPont Community Presbyterian Church

502 Barksdale Avenue, DuPont, Washington 9:00 am to Noon

 

Child’s Name ___________________________________________________

T-shirt size (circle) Adult  Sm/Med/Lg     Child  Sm/Med/Lg

Age: _______   Birth date ______________

Last grade completed in school ____________

Parent/Guardian Name _____________________________________________

Address __________________________________________________________

Mailing Address (if different) _______________________________________

Phone Numbers:

Home (        )_____________________________________________________

Work (       ) ______________________________Cell (       )__________________

E–mail ________________________________________________________

Medical Information:

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

___________________________________________________________

___________________________________________________________

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Emergency Contacts:

Name____________________________ Phone number_____________________

Name____________________________ Phone number_____________________

Dismissal Information:

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

___________________________________________________________

Do you attend Sunday School? If so where?

___________________________________________________________

If you are visiting our church, who are you a guest of?

___________________________________________________________

May we have permission to photograph your child?  Yes   No

May we have permission to use your child’s photograph for the purpose of promotion?  Yes    No

 

To Register contact: Fran Anderson (253-964-3098), or

mail to: 1770 Spencer Ct, DuPont WA, 98327

e-mail: dupont.granny@hotmail.com