2019 VBS Registration
Registration form for Clear Spring Baptist Church VBS 2019! Cannot wait to see you there! Please complete a registration form for EACH child. Thank you!
Email address *
Child's Name *
Your answer
Grade Completed *
Your answer
Birthday *
MM
/
DD
/
YYYY
Parent/Guardian Name *
Your answer
Home Address *
Your answer
Home Phone *
Your answer
Alternate Phone *
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
Relationship to Child *
Your answer
Food Allergies *
Required
If "YES" to food allergies, please list
Your answer
Medical Concerns *
Required
If "YES" to medical concerns, please list
Your answer
Family Doctor *
Your answer
Family Doctor Phone *
Your answer
Siblings Attending VBS at Clear Spring (Name and Age)
Your answer
Are you a Member of a Church? *
If "YES" to being a member of a Church, please list the name of the Church:
Your answer
Person 1 who can pick up your child (Name and Phone) *
Your answer
Person 2 who can pick up your child (Name and Phone)
Your answer
By Checking the box below, you are agreeing to permission for your child/children named above to be photographed/filmed for any lawful purpose associated with this VBS Program *
Required
Signature
Typing your name below constitutes your lawful signature that all information above is correct
Your answer
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