2017 Vacation Bible School
Lake Placid Baptist Church, Lake Placid NY
June 26-30 :: 4 years old through 5th grade
Pre-Registration Form
Must be completed by noon on Sunday, June 25. If past the deadline, please register on first morning of attendance.
Child's First Name
Your answer
Child's Last Name
Your answer
Child's Date of Birth
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DD
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Last Grade Completed
Parent/Guardian First Name*
Your answer
Parent/Guardian Last Name
Your answer
Mailing Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Best Phone Number to Reach Parent/Guardian
Your answer
Email Address
This information will be used only if we need to notify you with last-minute changes.
Your answer
Does child have any medical concerns or food allergies?
If you answered yes above, please list all medical and/or food allergy information below.
Your answer
Emergency Contact Name
Other than Parent/Guardian listed above.
Your answer
Emergency Contact Phone Number
Your answer
Please list name(s) of those adults, other than parent/guardian listed above, who have permission to pick up your child at the end of each day.
Your answer
Parent/Guardian Signature
Your answer
Today's Date
MM
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DD
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YYYY
Submit
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