Cosmic City Vacation Bible School
Registration Booth
Child Information
Note: Fields with a pink background are required.
Child's Name:
Grade in fall:
Birthdate:
Allergies or other important information we might need for your child's health or comfort (example: Vegitarian food only):
When possible, we will try to place your child in the same group as siblings and/or friends.
 
The following guidelines apply:
  • The children must be in the same age group (Pre-K, K, Grades 1-4, or Grades 5-8).
  • The children must be on each other's Requested Group Partner list.
We will make every effort to honor such friend / sibling Group requests.
My child would like to be in a group with:
 
Family Information
(at least 1 parent's name must be entered)
Mom's Name:
Dad's Name:
Email:
Street Address:
City, State, Zip:
Phone: ( ) -
Alternate Phone: ( ) -
 
Emergency Information
In the event that we cannot reach the parent(s) during an emergency, please provide an alternate emergency contact.
Emergency Contact:
Phone: ( ) -
Relationship to Child: