Join us at Evangel for Vacation Bible School! July 14-18 6-8:30 PM Mark your calendars now! *You may register now by filling out the form below and submitting it to us! Don't forget the Community Carnival! Wednesday, August 20 Invite your friends!           Child's Name * Gender * Female Male Child's Birthday (MM/DD/YYYY) * Last school Grade Completed * Do You go to Sunday School and/or Church? Yes No If So, Where? Parent(s) Name(s) * Home Phone Number * Cell Phone Number Work Phone Number Address * City * State * AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP Code * Please list medical, allergy, or other information we need to know: Emergency Contact * Phone Number for the Emergency Contact * Who May Pick-up this Child? * Phone Number for Child Pick-up * I, the undersigned parent/guardian of this minor child, give permission for this child to participate in Cosmic City VBS, July 14-18, 2008. I give my permission for my child's picture to be taken to be used in VBS publications or crafts. I hereby give permission for the adult bearer of this document to give consent for emergency medical or surgical treatment of my child by a licensed physician. I also understand and agree that I am granting permission of the aforementioned items by checking "I Agree" in the electronic signature area below. Electronic Signature * I Agree