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2022 Vacation Bible School Registration
Vacation Bible School Registration for Eastside Baptist Church
June 26-30
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Email
*
Your email
Child #1 First and Last Name:
*
Your answer
Child #1 Age:
*
Your answer
Child #1 Grade Completed:
*
Choose
K4
K5
1st
2nd
3rd
4th
5th
6th
Child #2 First and Last Name:
Your answer
Child #2 Age:
Your answer
Child #2 Grade Completed:
Choose
K4
K5
1st
2nd
3rd
4th
5th
6th
Child #3 First and Last Name:
Your answer
Child #3 Age:
Your answer
Child #3 Grade Completed:
Choose
K4
K5
1st
2nd
3rd
4th
5th
6th
Child #4 First and Last Name:
Your answer
Child #4 Age:
Your answer
Child #4 Grade Completed:
Choose
K4
K5
1st
2nd
3rd
4th
5th
6th
Parent First and Last Name:
*
Your answer
Address:
Your answer
City, State, Zip Code:
Your answer
Home Phone #:
Your answer
Cell Phone #:
*
Your answer
1st Emergency Contact Name:
*
Your answer
1st Emergency Contact Number:
*
Your answer
2nd Emergency Contact Name:
Your answer
2nd Emergency Contact Number:
Your answer
Allergies/Medical Conditions:
Your answer
1st Authorized Pick-up Name:
*
Your answer
1st Authorized Pick-up Number:
*
Your answer
2nd Authorized Pick-up Name:
Your answer
2nd Authorized Pick-up Number:
Your answer
Do you give Eastside Baptist Church VBS leaders permission to photograph and or video your child/children for any lawful purpose associated with this VBS program?
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No
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