Vacation Bible School at Broadway Campus: June 26-30, 2017
Join us for Vacation Bible School at the Broadway Campus of Highland Baptist Church (3215 Huntsville Road, Florence, AL 35630) Monday, June 26 - Friday, June 30 (9am-12pm), kids 4 years old - 6th grade.

(NOTE: Online registration will close Saturday night, June 24, 2017, but families may still register using a paper form at Broadway on Sunday morning, June 25, or Monday morning, June 26.)

Child's Name
Your answer
Street Address
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City, State, Zip Code
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Phone Number
Your answer
Age
Your answer
Birthday
MM
/
DD
/
YYYY
Grade Completed 2016-2017
What grade or school level did your child just complete?
Will your child need transportation?
A parent/guardian signature will be required in order for a child to ride the bus.
Parent Information
Parent or Guardian's Name
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Email address
Your answer
Does your family attend Sunday School and worship on a regular basis?
Required
If so, where?
Your answer
Other
Other information We Need To Know
Please let us know if there are any medications, allergies, or specific information that would help us better serve your child. If none, simply write "none".
Your answer
Emergency Contact Name and Phone Number
Your answer
Who is Authorized to Pick up Your Child from VBS?
Please list 1-3 people who are authorized to pick up your child from VBS. NOTE: They will be required to present PHOTO IDENTIFICATION to pickup a child. Thank you!
Authorized Person #1
Your answer
Authorized Person #2
Your answer
Authorized Person #3
Your answer
Photos and Videos
NOTE: By registering your child for VBS, You are giving consent for your child's image to be included in promotional pictures and video. No names will be included in connection with these images.
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