SHBC 2019 VBS Registration Form
Child's Name: *
Your answer
Child's Complete Address: *
Your answer
Birth date: *
MM
/
DD
/
YYYY
Grade entering: *
Parent/Guardian names and phone numbers: *
Your answer
Parent/Guardian complete address (or SAME): *
Your answer
Emergency contact name and phone number (if different from parent):
Your answer
My church home is:
Your answer
Allergies - please list (or NONE): *
Your answer
Medical concerns - please list (or NONE): *
Your answer
Email address (if you would like more information about future SHBC Kids' events):
Your answer
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