VBS 2019 BBC Registration Form
Registration for ages Pre-K thru 6th Graders JULY 7th - 11th 6:00 - 8:30 PM
CHILD'S LAST NAME *
Your answer
FIRST NAME *
Your answer
LAST GRADE COMPLETED *
NAME OF PARENT/GUARDIAN *
Your answer
ADDRESS *
Your answer
CITY *
Your answer
ZIP *
Your answer
PHONE *
Your answer
E-MAIL ADDRESS *
Your answer
EMERGENCY CONTACT *
Your answer
EMERGENCY PHONE *
Your answer
WHO CAN PICK UP CHILD? *
Your answer
ATTENDING WITH ANOTHER CHILD? IF SO, WHO? *
Required
DOES CHILD HAVE A PHYSICAL/MEDICAL NEED, OR ALLERGY?
Please explain.
Your answer
I give Bedico Baptist Church permission to use and/or publish my child's/grandchild's photo in BBC's promotional items (website, newsletter, advertisement, etc.).
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