WHBC VBS Learner Registration
Date: June 4-8, 2018
6pm-9pm
Dinner Served Nightly
Classes for all ages (Children in Nursery and Preschool must have a parent present either volunteering or in adult class)
Friday night is Family Night. ALL CHILDREN MUST HAVE A PARENT PRESENT THE ENTIRETY OF THE NIGHT.
Email address *
Student's Name *
Your answer
Student's Birthdate *
MM
/
DD
/
YYYY
What grade did student just complete? *
Parents' Names *
Your answer
Parent Cell Phone Number *
Your answer
Email Address *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Number *
Your answer
Emergency Contact #2 Name *
Your answer
Emergency Contact #2 Number *
Your answer
Who may pick up your child each night? *
Your answer
Does your child have any health issues that the volunteers at West Hills should be aware of? (food allergies, health issues, physical issues) *
Required
If yes, please list and explain. *
Your answer
West Hills has my permission to photograph and/or video my child. *
West Hills has my permission to use my child's photo/image for the purpose of promotion. *
Do you attend church regularly? *
If you answered yes above, where do you attend? If you answered no, please use "NONE". *
Your answer
Would you like to purchase a VBS tshirt for this person? *
If yes, what size would you like to purchase?
I understand that if my child (nursery-8th grade) attends on Friday night, a parent or grandparent must be present. *
Required
A copy of your responses will be emailed to the address you provided.
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This form was created inside of West Hills Baptist Church. Report Abuse - Terms of Service - Additional Terms