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2021 VBS Registration
Event Timing: April 5th - 9th, 2021 from 5:45-8:15 pm
Event Location: Bloomfield Baptist Church
106 Springfield Rd Bloomfield, KY 40008
Contact us at (502) 252-8435 or
dvinson@bloomfieldbaptist.org
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VBS Participant Name
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VBS Participant Grade
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Preschool (ages 3-4)
Kindergarten (ages 5-6)
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies/Special Instructions:
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Parent/Guardian Name(s)
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Parent/Guardian Email
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Parent/Guardian Phone Number
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Address
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Does your family regularly attend worship?
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If yes, where?
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Emergency Contact Name
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Emergency Contact Phone Number
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Emergency Contact Relationship to Participant
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The following people have permission to drop off/pick up my child:
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