Vacation Bible School Student Registration
9am to noon, July 8-12th, 2019
Ages 4-12 welcome, toilet trained required
Cost: FREE
Immanuel Baptist Church, 1424 24th Street
Parent Name *
Your answer
Parent email address *
Your answer
Parent phone number *
Your answer
Secondary emergency contact and number *
Your answer
In the unlikely event of an emergency, do you give permission to VBS staff to seek medical attention as needed for your child? *
Preferred hospital/medical record number
Your answer
Child 1 Name, Age (at July 8-12th), Allergies *
Your answer
Child 2 Name, Age (at July 8-12th), Allergies
Your answer
Child 3 Name, Age (at July 8-12th), Allergies
Your answer
Child 4 Name, Age (at July 8-12th), Allergies
Your answer
Child 5 Name, Age (at July 8-12th), Allergies
Your answer
Child 6 Name, Age (at July 8-12th), Allergies
Your answer
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