VBS 2019 Registration Form Date: July 22 - July 26, 2019 Time: 7:00 p.m. nightly PERSONAL INFORMATION Adult #1 Name Invalid Input Birth Month/Year (optional) Invalid Input Last School Grade Invalid Input Adult #2 Name Invalid Input Birth Month/Year (optional) Invalid Input Last School Grade Invalid Input Minor Child(ren) Child #1 Name Invalid Input Birth Month/Year Invalid Input Last School Grade Invalid Input Child #2 Name Invalid Input Birth Month/Year Invalid Input Last School Grade Invalid Input Child #3, Name Invalid Input Birth Month/Year Invalid Input Last School Grade Invalid Input Child #4, Name Invalid Input Birth Month/Year Invalid Input Last School Grade Invalid Input Address Invalid Input City, State, Zip Invalid Input Best Contact Phone/Mobile Number (Only One)(*) Invalid Input Email(*) Invalid Input MEDICAL INFORMATION Medical or other required information including food allergies (related name for each condition) Invalid Input Emergency Contacts/Who May Pick-up. Please give the name, relation and phone number for 1 to 3 persons. Invalid Input OTHER INFORMATION Do you and/or your child attend Sunday School? ( Select One) YesNo Invalid Input If yes, where? Invalid Input Are you and/or your child a member of any church? (Select One) YesNo Invalid Input If yes, where? Invalid Input If you are visting MCBC, whose guest are you? Invalid Input Do we have permission to photograph you and/or your child for promotional purposes? (Select One) YesNo Invalid Input Comments Invalid Input (*) Invalid Input