Berea Baptist VBS
August 7-11
6:00pm - 8:15pm
Free Dinner each night at 5:30

Berea Baptist Church
15475 Ashland Rd, Rockville VA 23146
804-749-3597

Child's First Name
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Child's Last Name
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Child's Gender
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Grade entering this fall (2017-2018 school year)
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Child's Date of Birth
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Parent Email
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Parent Phone #
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Home Address (number, city, state, zip)
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Known Food Allergies
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Medical Concerns
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Emergency Contact During VBS Hours (name and phone#)
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Photo Release - I give permission for photos to be taken of my child during VBS, with the understanding that some photos may be used on Berea's website and social media accounts.
How did you hear about our VBS?
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