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