Vacation Bible School at Highland Baptist Church: June 12-16, 2017
Join us for Vacation Bible School at Highland Baptist Church 7-Points Campus (219 Simpson Street, Florence, AL 35630) Monday, June 12 - Friday, June 16 (9am-12pm), for kids 4 years old - 6th grade.

(NOTE: Online registration will close Saturday night, June 10, 2017, but families may still register using a paper form at Highland Baptist Church on Sunday morning, June 11, or Monday morning, June 12.)

Child's Name
Your answer
Street Address
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City, State, Zip Code
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Phone Number
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Age
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Birthday
MM
/
DD
/
YYYY
Grade Completed 2016-2017
What grade or school level did your child just complete?
Parent Information
Parent or Guardian's Name
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Email address
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Does your family attend Sunday School and worship on a regular basis?
Required
If so, where?
Your answer
Other
Other information We Need To Know
Please let us know if there are any medications, allergies, or specific information that would help us better serve your child. If none, simply write "none".
Your answer
Emergency Contact Name and Phone Number
Your answer
Who is Authorized to Pick up Your Child from VBS?
Please list 1-3 people who are authorized to pick up your child from VBS. NOTE: They will be required to present PHOTO IDENTIFICATION to pickup a child. Thank you!
Authorized Person #1
Your answer
Authorized Person #2
Your answer
Authorized Person #3
Your answer
Photos and Videos
NOTE: By registering your child for VBS, You are giving consent for your child's image to be included in promotional pictures and video. No names will be included in connection with these images.
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