COH VBS Registration

Today's Date
Child's Name
Date of Birth
Age
Grade Level Completed
Address
Home Phone
Email
Parents/Guardian Info
Mother's Name
Phone
Cell Phone
Father's Name
Phone
Cell Phone
Emergency Contact Name (other than parent)
Phone
Cell Phone
Allergies or other conditions which may limit activity:
Other important info we need to know about your child:
VBS is FREE $12.00 for T-shirt and music CD (Cash or Check made out to COH due by first day of VBS)
Please choose which size T-shirt your child would like:
I give my permission for my child's picture to be taken during VBS: (pictures may be used in COH print and digital media, including the COH website)
	Yes No
Pictures may be used in COH print & digital media, including the COH website.