Registration 2019
June 9th - June 13th- (6:00pm - 8:30pm) Dinner @ 5:30pm
Students must be registered in order to attend VBS.
(A form must be completed for each child attending individually. Sorry for the inconvenience.)
Student's First Name: *
Your answer
Student's Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age:
Your answer
Current Grade Level: (grade you just completed) *
Required
Special Education/Special Needs (Additional Info)
Your answer
Address: (Street address only) *
Your answer
City, State, Zip Code: (Ex. Lebanon, TN, 37090)
Your answer
Parent(s) or Legal Guardian Names *
Your answer
Cell/Work Number - Ex. (615) 449-6647 - Cell *
Your answer
Emergency Contact: (Ex. Aunt, Uncle, Best Friend etc.) Jane Doe - Aunt *
Your answer
Emergency Contact Number: (Ex. 615-449-6647 - Aunt) *
Your answer
During VBS, I permit my child to be picked up by: (Ex. Jane Doe - Mother, John Doe - Grandfather etc.) *
Your answer
List any food allergies or health conditions. *
Your answer
E-Mail *
Your answer
I permit my child's name and food allergies to be posted for VBS staff members to see. *
I permit VBS staff to administer bug repellent and or sunscreen to my child during outdoor activities in the event that either becomes necessary. *
Pictures of my child may be used in future VBS promotional material/website. *
My Child has permission to attend and participate in VBS Summer Camp at Rocky Valley Baptist Church. *
Signature/Date: (Ex. Jane Doe - 5/15/2016) *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service