Midwood Baptist VBS Registration
Event Timing: July 7th-10th, 2019
Event Address: 2029 Mecklenburg Ave, Charlotte, NC 28205
Contact us at 704.376.8944 or baldwin.annagrace@gmail.com
Registration Form
Please complete all required fields and register for each child individually.
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade Completed
Age *
Your answer
Parent/Guardian's Name *
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Primary Phone *
Your answer
Secondary Phone
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Special Needs / Allergies / Other Concerns *
Your answer
Photo Release
By filling out this form I also agree to the following release of information regarding my child: The church may feature my child in broadcast and print media, on the church website, and publications and programs.
Parent Affirmation *
Please type your full name to affirm the above information is correct and you understand the photo release.
Your answer
Email
Your answer
Submit
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