Parent Information
Parent/Guardian's Names   
Address   
City        State        Zip   
Home Phone        Email   
Mom's Cell     Dad's Cell 
Member/Regular Attendee of Alice Drive Baptist Church?     Yes     No
 I would like to volunteer to help during VBS.   Please contact me.

Emergency Information
Local Emergency Contact Name  
Home Phone      Cell Phone  

Child Information
Must be 4 yrs old by September 1, 2008
Child's Name  
Birth Date  
Grade Completed May 2008





Allergies, Medical Needs, Security Risk  
One classmate request will be considered until July 4


2nd Child to be registered
Child's Name  
Birth Date  
Grade Completed May 2008





Allergies, Medical Needs, Security Risk  
One classmate request will be considered until July 4


3rd Child to be registered
Child's Name  
Birth Date  
Grade Completed May 2008





Allergies, Medical Needs, Security Risk  
One classmate request will be considered until July 4

Additional Information