Life Renewal Charismatic Church - Vacation Bible School Registration

Gender

Child's First Name

Child's Last Name

Birthdate

Last Grade Completed In School

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

Parent/Guardian's First Name

Parent/Guardian's Last Name

Information (specify): Medical Or Other Information We Need To Know. (Please Include Any Food Allergies)

First Name

Last Name

Phone Number

Dismissal Information:

Do you attend church? If so where?

Do you attend Sunday school? If so where?

May we have permission to photograph your child?

Yes

No

May we have permission to use your child’s photograph in church publications for the purpose of promotion?

Yes

No

Other Information or Comments

Vacation Bible School Registration