2016 Vineville Baptist Church VBS
2016 Vineville Baptist Church VBS
Dates: June 6-10, 2016
Times: 9AM - 12PM
Registration Form
Child's Name
*
First
Last
Parent or Guardian's Name
*
First
Last
Address
*
Street Address
Address Line 2
City
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Email Address
*
Home Phone
*
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Cell Phone
*
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Work Phone
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Age Information
Age
*
(as of VBS date)
Child's Date of Birth
*
/
MM
/
DD
YYYY
Last School Grade Completed
*
Home Church
*
Allergies / Medical Information / Other
*
Emergency Contacts
Name of Contact Person #1
*
First
Last
Phone Number Contact #1
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Name of Contact Person #2
First
Last
Phone Number Contact #2
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Dismissal Information
Name of Person other than Parent/Guardian Authorized to Pick up Child #1
*
First
Last
Name of Person other than Parent/Guardian Authorized to Pick up Child #2
First
Last
Name of Person Authorized to Pick up Child from VBS
First
Last