Outrigger Island VBS Registration
Child''s First Name: *
Child''s Last Name: *
Date of Birth: *
Gender: *
Please Enter Your Contact Information.
Parent/Guardian''s Name: *
Street Address: *
City: *
State: *
Zipcode:
Home Phone:
Work Phone:
Cell Phone:
Email: *
Please Tell Us The Last Grade Your Child Has Completed.
Last Grade Completed: *
Does Your Child Have Any Allergies, Medical Needs, or Special Needs We Need To Know About?
Allergies, Medical or Special Needs:
Energency Contact Name (1): *
Emergency Contacy Phone Number (1): *
Energency Contact Name (2): *
Emergency Contacy Phone Number (2): *
Please Provide The Name Of At Least One Person Authorized To Pick Up Your Child In Your Absence.
Authorized Pickup (1): *
Authorized Pickup (2):
Authorized Pickup (3):
Authorized Pickup (4):
Please Tell Us About Your Church Affiliation.
Are You A Member Of Friendship Church?
No, I Am A Guest Of:
Do You Attend Church?
If So, Where?
Picture Permission
May We Have Permission To Photograph Your Child?
May We Have Permission To Use Your Child''s Photograph in Church Publications?