Child's Name *
Child's Name
Parent or Gaurdian *
Parent or Gaurdian
Phone *
Phone
Home Address
Home Address
Gender *
List each sibiling's name AND entering grade level. If contact information is DIFFERENT, please complete a separate form
Emergency Contact *
Emergency Contact
Phone *
Phone
List the names of those who have your permission to pick up your child by 12.00pm. A photo ID will be required for those listed here. Matching ID bracelets may also be required.
Permission to use your child's photograph in future VBS promotional material by Mountainside Church of Christ