MHBC Galactic Starveyors VBS Registration
July 10th-14th, 2017
9am - 12pm
Mount Hermon Baptist Church
Fellowship Hall
Ages: Entering Kindergarten to Completed 6th Grade
Child's Name *
Your answer
Parent/Guardian's Name *
Your answer
Address *
Your answer
Mailing Address (if different)
Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Parent/Guardian's Email *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Grade Completed *
Medical or other information that we need to know. (Please include any food allergies.)
Your answer
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 Name
Your answer
Emergency Contact #2 Phone Number
Your answer
Please list three people who have your permission to pick up your child.
Your answer
Does your child attend church? If so, where?
Your answer
If your child is visiting our church, who is he/she a guest of?
Your answer
May we have permission to photograph your child? *
May we have permission to use your child's photograph for the purpose of promotion? *
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