Please fill in all pertinent info below. We will respond via email or phone to confirm your child(ren)'s registration. Thank you!
Child's Name and Grade (next school year):*
T-shirt Size*
2nd Child's Name and Grade:
2nd Child's T-shirt Size
3rd Child's Name and Grade:
3rd Child's T-shirt Size
4th Child's Name and Grade:
4th Child's T-shirt Size
Parents' Name(s):*
Address/City/State:*
Phone:*
Daytime Phone (enter "same" if same as above):*
Email address:
Member of (List church name, or "None"):
Please check below to signify that you give permission for the above child(ren) to be photographed at Immanuel's 2012 VBS and have no objections to such photographs being used on Immanuel's website, in local media or in promotional fliers. (Children's names will not be included with photographs posted on Immanuel's website.)
How did you hear about Immanuel's VBS program?
Please list any questions or special requests here, as well as any food allergies or health concerns for your child(ren).
