First Baptist Church of Fairbury Vacation Bible School Registration
June 12th - June 16th
9:00 a.m. - 11:15 a.m.
Name of Child
Your answer
Child's Date of Birth
Your answer
Parent / Guardian Name (s)
Your answer
Your answer
Parent / Guardian's Phone Number
Your answer
Are you interested in helping with VBS?
Grade Entering Fall 2017
Important! Does your child have any allergies or medical conditions the staff should know about?
If yes, please specify, and list medications and dosage:
Your answer
Emergency Contact Information
Please list two individuals that we may call if there is an emergency and we are unable to reach you.
Name and Phone Number of Contact #1
Your answer
Name and Phone Number of Contact #2
Your answer
Please list any additional individuals that have permission to pick-up your child from FBC.
Your answer
By completing this form you are giving consent for your child to participate in the First Baptist Church of Fairbury VBS program
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