Dudley Baptist VBS Registration Form
Event Timing: June 23-27 - 5:30-8:30pm
Event Address: 1245 2nd Street, Dudley, GA 31022
Contact us at : 478-676-3186 or 478-494-4256
Name *
Your answer
Parent/Family/Guardian Name *
Your answer
Address: *
Your answer
Email Address: *
Your answer
Phone Numbers: Home, Cell & Work *
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Age:
Your answer
Last School Grade Completed:
Your answer
Friends of your child at this church:
Your answer
Special Needs/Allergies/Medical Information/Other:
Your answer
Emergency Contacts: Name & Phone
Your answer
Name(s) of person(s) who may pick up your child from VBS.
Your answer
Photo Release: Dudley Baptist Church has my permission to us my child's photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
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