Registration Form
Classes available for all ages! Please complete all questions to register your child and/or yourself for VBS @ Riverview Baptist Church. Enter n/a to any question that is not applicable.
Registrant's Name *
Your answer
Parent/Guardian Name *
Your answer
Address *
Your answer
Mailing Address (if different)
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Work Phone *
Your answer
Email *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Age *
Grade completed as of June 1st *
if not in school select nursery or adult
Medical Information *
Medical or other information we need to know (please include food allergies and instructions for treatment)
Your answer
Emergency Contact Information
Please enter an emergency contact other than parent/guardian
Contact Name #1 *
Your answer
Contact #1 Phone Number *
Your answer
Contact Name #2
Your answer
Contact #2 Phone Number
Your answer
Dismissal Information
Who may pick up your child at the end of each VBS day?
Name *
Your answer
Does your child and/or you attend Sunday School? *
Required
Is so, where?
Your answer
If your child is visiting our church, who is he a guest of?
Your answer
May we have permission to photograph your child and/or you? *
Required
May we have permission to use your child's and/or your photograph for the purpose of promotion? *
Required
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