FBC Counce VBS 2019 "In the Wild"
July 15-19, 2019
Email address *
Child's First & Last Name (1): *
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Gender (1):
Birthdate (1): *
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Grade child is entering (1) *
Child's First & Last Name (2):
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Gender (2):
Birthdate (2):
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Grade child is entering (2)
Child's First & Last Name (3):
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Gender (3):
Birthdate (3):
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Grade child is entering (3)
Child's First & Last Name (4):
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Gender (4):
Birthdate (4):
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Grade child is entering (4)
Child's First & Last Name (5):
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Gender (5):
Birthdate (5):
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DD
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YYYY
Grade child is entering (5)
Parent/Guardian Name: *
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Address: *
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City: *
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State: *
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Zip: *
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Phone: *
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Allergies, Medical & Special Needs (Leave Blank if None)
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Permission to Treat:
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I am the/a parent and/or legal guardian of the child I am enrolling. I understand it is my responsibility to notify the classroom leaders as to where I can be reached in the event of an emergency. *
Emergency Contact Name & Number (1): *
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Emergency Contact Name & Number (2):
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Custody Concerns?: If yes, list the concerns here and notify class leaders or Directory.)
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Authorized Pickup #1: *
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Authorized Pickup #2:
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Does your child need a ride? *
Are you a member of this church? *
Guest of:
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Do you attend church? If so, where? *
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May we have permission to photograph your child? *
May we have permission to use your child's photograph in church's publications? *
Select a t-shirt size: (if you want one and do not have one ordered already, we have a few extra sizes $10 each )
Comments:
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