VBS 2018 Registration
Please fill out the following form to register each child separately. We look forward to serving your children this summer.
Name of Child (First Name)
Your answer
Name of Child (Last Name)
Your answer
Parents Name (First and Last)
Your answer
Address (Line 1)
Your answer
City & State
Your answer
Zip
Your answer
Parent Email Address
Your answer
Parent Phone (For Emergency Only)
Your answer
Child's Age
Your answer
Child's Date of Birth
Your answer
Child's Grade (in the Fall)
Your answer
Child's Allergies and Health Concerns
Your answer
Name of Friend Your Child Would Like To Be Placed With
We will try to honor this request as we schedule the groups
Your answer
Name of Church Your Family Attends
Leave blank if you are currently not attending church
Your answer
Do you grant permission for your child's photo to be taken and potential posted on the church's website and/or Facebook.
Please check below if you do or do not want your child's photo to be taken by Park Hills Baptist Church.
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