Parents' Names:

  Address:    City:           State:    Zip:

  Home Phone:     Work Phone:   Cell Phone:    Email Address:

  Home Church:  

Emergency Contact:   Relationship:   Phone:

Allergy/Health Conditions:

                                                              Child 1-
                                                                Name:     Age:     Grade:  

                                                              Child 2-
                                                                Name:     Age:     Grade:  

                                                              Child 3-
                                                                Name:     Age:     Grade:  

                                                              How did you find out about VBS at Edgewood?
                                                                  

                                                              Additional Comments:
                                                                 

                                                 By submitting this form, you give permission for your child to participate in this year's VBS program at Edgewood.