FBC Jackson MN - 2019 VBS
For children 3 years old through 5th grade
Contact us at (507) 847-2369 or office@fbjackson.org
Parent Information
Parent/Caregiver name: *
Your answer
Address *
Your answer
Phone *
Your answer
Other adult(s) permitted to pick up child
Name - Phone
Your answer
Emergency Contact - Phone - Relationship to child
Your answer
We will use this contact information in the event of a medical emergency. In the event of an emergency & the contacts listed can not be reached your child to be transported to the Jackson Hospital.
Children registration on following page.
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