Ivy Memorial Baptist Church

Child's Name:  

Parent / Guardian Name:

Birthday  Last grade completed in school Pre-K age 4Kindergarten1st2nd3rd4th5th6th

Add Brother(s) or sisters(s)

Name                                     Birthday                            Last Grade Attended

          Pre-K 4Kindergarten1st2nd3rd4th5th6th

          Pre-K 4Kindergarten1st2nd3rd4th5th6th

          Pre-K 4Kindergarten1st2nd3rd4th5th6th

Address: Street 

                  City     State       Zip

Phone #:      Home 

                     Work 

                       Cell 

E-mail address:

Medical or Food Allergy information we need to know

Emergency Contacts (At least one contact name and number is required)

Name    Phone # 

Name    Phone # 

Dismissal information

Who may pick up your child at the end of each VBS day?  (You may enter as many names as necessary)

Other Information

Do you attend Sunday School? If so where?

How did you hear about our Vacation Bible School?

Did someone invite you to VBS this year?  If so, who?

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? (newsletters, brochures, or on the website)     Yes     No