2017 FBC Middletown VBS Registration
Participant's Full Name:
Your child's first and last name.
Your answer
Parent/Guardian's Full Name:
The parent or guardian's full name.
Your answer
The participant's full address including City, State, Zip.
Your answer
Home Phone:
The participant's home phone.
Your answer
Cell Phone:
The parent/guardian's work phone.
Your answer
The parent/guardian's email address.
Your answer
Participant's Birthday:
The participant's birthday (MM-DD-YYYY)
Your answer
Last Grade Completed:
The current age or last grade the participant completed.
Allergies, Medical & Special Needs:
Leave blank if none.
Your answer
Emergency Contacts - Name + Phone
Please enter one or more emergency contact name(s) and phone number(s).
Your answer
Authorized Pickup Names
Please enter one or more authorized pickup names
Your answer
Where do you go to church?
Participant Photograph Permission
May we have permission to use your child's photograph in church publications?
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