Hearts Under Construction: Building a Life with Jesus
Broad Run Baptist Church Vacation Bible School
When: July 31 -August 4, 2017
Event Address: Broad Run Baptist Church, 675 Broad Run Rd, Jane Lew, WV 26378
Contact us: (304)884-7413 Church Office
Child's First Name
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Child's Last Name
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Nickname?
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Parent/ Guardian's Full Name
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Street Address
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Town/City
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State/ Zip
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Primary Phone Number
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Parent/ Guardian Email
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Child will be in ______ grade when school starts.
Any known food allergies, medical concerns?
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Emergency Contact (other than primary parent/ guardian listed above)
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Emergency Contact Phone Number
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Please list others who are allowed to pick your child up from our event. (i.e. Grandparents, Aunts, Uncles, Family Friends, etc)
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Are you members of a church? (answer not required)
By registering my child, I understand that his/her photo may be used for church purposes, like presentations or publications. I understand I can discuss any questions or concerns with the pastor and/or the VBS coordinators.
Required
Thank you for registering! We are looking forward to a GREAT EVENT!!! ~Each One, Reach One 2017~
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