2018 Vacation Bible School
Lake Placid Baptist Church, Lake Placid NY
June 25 - 29 :: 4 years old through 5th grade
Pre-Registration Form
Must be completed by noon on Sunday, June 24.
If past the deadline, please register in person on your child's first morning of attendance.
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
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Last Grade Completed *
Parent/Guardian First Name* *
Your answer
Parent/Guardian Last Name *
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Best Phone Number for Parent/Guardian *
Your answer
Email Address *
Your answer
Does child have any medical concerns or food allergies? *
If you answered yes above, please list all medical and/or food allergy information below. *
Your answer
Emergency Contacts / Permissions *
Please list adults (other than parent/guardian listed above) who have permission to make decisions for your child in case of an emergency and/or pick up your child at the end of each day. *Note: they must have pick-up tag or show ID.
Your answer
May we have permission to photograph your child for use in promotional media?
Parent/Guardian Signature *
Your answer
Today's Date *
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