Registration Form

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Registration Form (one form per family)

Name(s):

Grade(s) entering:

Gender:

Street Address: City, State Zip: Name of Parent/Guardian: Parent/Guardian primary phone: alternate phone: email address: In case of emergency, contact: (name and phone)

Allergies or other medical conditions:

Person(s) other than parent/guardian who are authorized to pick up children:

Any special scheduling needs? (nights absent) Number of family members participating in VBS (attendee or volunteer): Will parents be helping in any area of VBS? Home church, if applicable: Name of a special friend your child might like to be with: Please return completed form to: Roseau Evangelical Covenant Church 1717 3rd Street NE, PO Box 268 Roseau, MN 56751

Where?