VBS Registration - Emmanuel Baptist Church
July 19-23, 2021 from 6:00pm-8:30pm (Ages 3 - completed 5th grade)
Please fill out one form per child attending
* Required
Email
*
Your email
Child's Name (Last, First, MI)
*
Your answer
Name Child Likes To Be Called, If Different Than Above
Your answer
Grade Completed
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
Age On July 19, 2021
*
Your answer
Parent's Name(s)
*
Your answer
Home Address
*
Your answer
Contact Phone Number
*
Your answer
Alternate Phone Number
Your answer
Emergency Contact Person
*
Your answer
Relationship To Child:
*
Your answer
Emergency Contact Person Phone Number
*
Your answer
Emergency Contact Person Alternate Phone Number
Your answer
Child Food Allergies
*
YES
NO
Required
If YES, Please List
Your answer
Medical Concerns
*
YES
NO
Required
If YES, Please List
Your answer
Child's Doctor
Your answer
Doctor's Phone
Your answer
Siblings Attending VBS (Names & Ages)
Your answer
Church Affiliation
Your answer
Church Membership At
Your answer
Person(s) Name(s)/Phone Number(s) Who May Pick Up The Child
*
Your answer
Church Staff/VBS Leaders Have Permission To Photograph The Child Designated Above For Any Lawful Purpose Associated With This VBS Program
*
YES
NO
Anything Else We Need To Know
Your answer
A copy of your responses will be emailed to the address you provided.
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