CC Sweet Hills VBS

Parent/Guardian First Name

Last Name

Phone Number

Child's First Name

Child's Last Name

Grade (Last grade completed)

Birthdate

Child's Age

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Allergies

Medical Information

May we have permission to photograph your child?

Yes

May we have permission to use your child's photograph for the purpose of promotion?

Yes

Emergency Contact Information

Phone Number

Who has permission to pick up your child from VBS

Signature