2024 Antioch Baptist Church VBS  Registration
Our VBS will begin at 5:45 and end at 8:30; drop-in optional meal starts at 5:00. Please complete the information in this form so we can provide a safe, supportive environment for your child.
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Child's name *
Child's Age *
Child's Birth Date *
MM
/
DD
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YYYY
Address *
Last School Grade Completed (as of June 2024) *
Name of Parent/Guardian #1 *
Phone Number of Parent/Guardian #1 *
Name of Parent/Guardian #2
Phone Number of Parent/Guardian #2
Please list name and phone number of any adults who will be picking up your child.
Emergency Contact Name and Phone Number *
Child's Known Allergies or Medical Conditions *
Is there anything else we need to know to better serve your child?
I give permission for my child to appear in photos and/or video footage taken throughout the week. *
Required
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