Agency D3 - Registration
Vacation Bible School
FBC Rockdale - June 4-7
9 AM - 12:00 pm
Child's First Name *
Your answer
Child's Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Grade (completed) *
How do you want to pick up your child? (This year we are going to release kids who sign-up for the carpool line on the Bell St. side of the church. Walk In pick-up will take place in the building where registration takes place) *
Your Church Home
Your answer
Street Address *
Your answer
City *
Your answer
Email Address *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Allergies?
Your answer
Submit
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