Poplar Ridge Friends Meeting - VBS Registration

Child #1 First Name

Child #1 Last Name

Child #2 First Name

Child #2 Last Name

Child #3 First Name

Child #3 Last Name

Child #4 First Name

Child #4 Last Name

Parent / Guardian's First Name

Parent / Guardian's Last Name

Parent / Guardian's Cell Number

Address

City

Zipcode

Church you attend (you can list "none")

Have any of your children attended VBS at Poplar Ridge before?
Yes
No
Not Sure

Additional Parent or Emergency Contact - First Name

Additional Parent or Emergency Contact - Last Name

Relationship to the Child(ren)

Emergency Contact #2

Any Allergies, Special Instructions (please specify which child), Comments, or Additional Emergency Contacts