Child's Present Age:
2016/2017 School Grade:
List below any known allergies (including food allergies) and any health problems:
Do you give permission to have your child's photograph taken during the VBS program and display these photos to the public (via Columbia Church of God's website and Facebook page)?
Parent or Guardian
Parent/Guardian Address, if different
Contact Phone Number:
Other Contact Phone Number (optional):
Other Persons Allowed to Pick Up Your Child After the End of Each VBS Day
Home Phone Number
Work Phone Number
Cell Phone Number
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Does your family attend a church?
Church Name (optional):
Would you like to receive more information about Columbia Church of God?