VBS Registration Form 2017
CHILDREN AGES 4 THROUGH 5TH GRADE are eligible to participate in VBS. Please complete this form to register your child(ren) for VBS at Village Baptist Church. A separate form must be completed for each child attending. Be sure to scroll through all items and click the submit button at the bottom of the form.
Child's Last Name
Your answer
Child's First Name
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Last grade completed in school
Choose one
Address
Number and Street
Your answer
City
Your answer
State
Your answer
Zip code
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email address of parent/guardian
Your answer
Name of Parent(s)/Guardian(s)
Your answer
Emergency Contact Information
Your answer
Relationship to child
Your answer
First and last name(s) of person(s) authorized to pick up child from VBS
Your answer
Primary phone number of person authorized to pick up child from VBS
Your answer
email address of person authorized to pick up child
Your answer
List all allergies and/or other pertinent medical information
If none, please type "none"
Your answer
Does your child attend Village Baptist Church
If not, please answer the next question
Name of home church
optional
Your answer
Would you like to volunteer to help with VBS?
optional
Submit
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