Outrigger Island
Vacation Bible School Registration Form
Please fill this form completely to register for Outrigger Island!.
First Child's Full Name :
School Grade Completed :
Pre
K
1
2
3
4
5
DOB :
(M/D/Y)
Second Child's Full Name :
School Grade Completed :
Pre
K
1
2
3
4
5
DOB :
(M/D/Y)
Third Child's Full Name :
School Grade Completed :
Pre
K
1
2
3
4
5
DOB :
(M/D/Y)
Fourth Child's Full Name :
School Grade Completed :
Pre
K
1
2
3
4
5
DOB :
(M/D/Y)
Parent/Guardian Full Name :
Address (Street/Apt/Etc) :
City :
Zip :
Phone :
Emergency Contact Full Name :
Emergency Contact Phone/Cell :
Do you attend a local church?
Yes
No
If yes, which church?
Additional Questions/Comments/Concerns (i.e. food allergies) :
