2018 FBC Middletown VBS Registration
June 24th-28th, 2018 | 11721 Main Street | Middletown, KY 40243 | 502-245-7889
Participant's Full Name: *
Your child's first and last name.
Your answer
Parent/Guardian's Full Name: *
The parent or guardian's full name.
Your answer
Address: *
The participant's full address including City, State, Zip.
Your answer
Home Phone:
The participant's home phone.
Your answer
Cell Phone:
The parent/guardian's work phone.
Your answer
The parent/guardian's email address.
Your answer
Participant's Birthday:
The participant's birthday (MM-DD-YYYY)
Your answer
Last Grade Completed: *
The current age or last grade the participant completed as of June 2018.
Allergies, Medical & Special Needs:
Leave blank if none.
Your answer
Emergency Contacts - Name + Phone *
Please enter one or more emergency contact name(s) and phone number(s).
Your answer
Authorized Pickup Names *
Please enter one or more authorized pickup names
Your answer
Where do you go to church?
Participant Photograph Permission *
May we have permission to use your child's photograph in church publications?
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