Gospel
Express! Registration Form
Child’s Name:
_____________________________________________________
Parent/Guardian Name: ____________________________________________
Address:
__________________________________________________________
Home telephone: ___________________ Cell phone: ___________________
Home e-mail address:
______________________________________________
Child’s age: ______________ Last school grade completed:
___________
Home congregation (if any): _________________________________________
In case of emergency (when the parent/guardian cannot be
reached) please contact:
Name:
_____________________________________________________________
Telephone:
_________________________________________________________
Relationship to child:
________________________________________________
Please list any allergies (including food allergies) the VBS staff
should be aware of:
______________________________________________________________________
______________________________________________________________________
Person responsible for picking up this child at the end of
each VBS day:
Name:
_______________________________________________________________
Telephone number:
___________________________________________________
Signature of parent/guardian:
_______________________________________________________________________
Please return
registration for to St. Matthew’s Church,
Please call Fr.
Scott Garno at 369-3081 or email frscott@frontiernet.net
if you have any questions.