Register Early Preschool Enrollment Is Limited and Spots Fill up Fast!

Register early – Preschool enrollment is limited and spots fill up fast!

Note: Child must be 4 years old by July 1st. If your child will go to Kindergarten in the fall, they will register as an Elementary participant.

Child’s Name: Click and type.

Age: Click and type. DOB: Click here to enter date. ☐ Male ☐ Female

Preschool: Child must be 4 years old by July 1st. Select age as of July 1, 2017: ☐ Age 4 ☐ Age 5

If preschool age, is child potty trained? ☐ Yes ☐ No

Elementary: Select school grade your child will be in for 2017-2018: ☐ K ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5

List any allergies or other medical conditions: Click and type.

List any medicine your child may require for an allergic reaction (i.e. epi pen): Click and type.

If child has special needs, name of adult who will accompany child: Click and type.

Name of one special friend your child might like to be in a crew with (must be in the same age category):

Click and type.

Contact Information

Child’s Street Address: Click and type.

City Click and type. State Click and typeZip Click and type. Home Telephone: Click and type.

Mother’s Name: Click and type.

Daytime Phone: Click and type. Email Address: Click and type.

Father’s Name: Click and type.

Daytime Phone: Click and type. Email Address: Click and type.

In case of emergency contact, other than parent/guardian: Click and type.

Relationship: Click and type. Daytime Phone: Click and type.

Do you have a home church? ☐ Yes ☐ No

If yes, please provide name of home church: Click and type.

Donation (to help cover the cost of VBS): $Click and type.

Do we have your permission, as a parent or guardian, to include your child in photos taken during VBS? Photos will be posted without names on the church’s Facebook page and on our website. Photos will also decorate various bulletin boards within the church building. Again, no names will be assigned to these photos. ☐ Yes ☐ No