2019 VBS Preregistration Form
Our online form to preregister for Vacation Bible School at Brushy Fork Baptist Church
In any fields that have no answer please put "none" in the field.
Primary Email address *
Secondary Email address
Child's Name *
Child's Birthday *
Mother's name *
Father's name *
Home Phone *
Mother's Cell *
Father's Cell *
Mother's Work Phone *
Father's Work Phone *
Street Address *
City *
State *
Zipcode *
Emergency Contact(s) - please put first and last name then best phone number for each contact [example: John Doe - 555-555-5555]. *
Who may pick up your child at the end of each day of VBS? If there will be a regular pick up person then please just list their first and last name with phone number. If there will be multiple pick up persons then please list the first, last name, and phone number along with the days they have permission to pick up your child. *
Allergies we need to be aware of and/or Medications the child is taking *
Child's Doctor - please list first name, last name, and phone number *
In the event of an emergency situation, I give Brushy Fork Baptist Church permission to seek medical attention for my child. *
Age of School Grade Just Completed *
Name of Church, if any
Name of Pastor
I hereby grant permission for Brushy Fork Baptist Church to photograph and/or video my child and use those pictures and/or video for a highlight video and/or slideshow on their website for informational and promotional purposes. *
Any comments?
By placing check here I certify that I have reviewed the information on this form and it is correct as far as I know *
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