2010

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2010

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2010 © Bogard Press. Permission granted to reproduce for use with VBS 2010 Soul Survivors on Danger Island program only – not for resale.

2010

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Student’s name ______________________________________________________ Male/Female ____________

Address ___________________________________ City __________________ State ______ Zip __________

Home telephone (___) ________________________ E-mail address: ___________________________________

Date of birth _____/_____/_____ Age _______ Last school grade completed _______________________________

Home church _________________________________________ City _______________________ State _____

Brother or sister’s name ________________________________ Other _____________________________________

Name of a special friend your child might like to be with ___________________________ Need transportation?_________

Parent/Guardian name ____________________________________ Home phone # (_______) ________________

Mom’s cell # (______) __________________________ Mom’s work # (______) __________________________

Dad’s cell # (______) ___________________________ Dad’s work # (______) __________________________

Allergies/Medical conditions ____________________________________ Emergency contact __________________

Phone # (___) ________________________ Relationship to child _____________________________________

Person other than parent authorized to pick up your child _________________________________________________

Parent / Guardian Signature ___________________________________________ Date _____________________

Name ______________________________________________________ Phone _______________________

Address ___________________________________ City __________________ State ______ Zip __________

Age _______________ Last grade in school ______________________________________________________

Church Member? ___________ What church? _____________________________________________________

Attends Sunday School where? __________________________________________________________________

Father’s Name ____________________________________________________ Attends Sunday School? ________

Mother’s Name ____________________________________________________Attends Sunday School? ________

Assigned to ____________________________________________________ Class _____________________

Teacher _______________________________________________________ Transportation Needed? _________

RegistRation CaRd

ReCoRd CaRd Circle days attendedM T W Th F

2010

© B

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Per

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Soul

Sur

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prog

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201

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