VBS 2017 Registration Form June 11-15
Must be at least 18 years to fill out and submit this form (List up to 3 children on this form)
Email address *
Parent/Guardian Name *
First and Last Name
Your answer
Complete Address/Apartment # *
Street Address with Apartment #, City, SC
Your answer
Home Phone # *
Your answer
Cell Phone # *
Your answer
In Case of Emergency Contact Name *
First and Last Name
Your answer
Emergency Contact Phone # *
Your answer
Emergency Contact Relationship to Child *
Your answer
Child #1 Name *
First and Last Name
Your answer
Child #1 Age (date of birth, if preschooler) *
MM
/
DD
/
YYYY
Child #1 Last grade completed *
Child #1 Please list any allergies/medical problems that your child has: *
Your answer
Child #1 Please list any food allergies that your child has: *
Your answer
Child #2 Name
First and Last Name
Your answer
Child #2 Age (date of birth, if preschooler)
MM
/
DD
/
YYYY
Child #2 Last grade completed
Child #2 Please list any allergies/medical problems that your child has:
Your answer
Child #2 Please list any food allergies that your child has:
Your answer
Child #3 Name
First and Last Name
Your answer
Child #3 Age (date of birth, if preschooler)
MM
/
DD
/
YYYY
Child #3 Last grade completed
Child #3 Please list any allergies/medical problems that your child has:
Your answer
Child #3 Please list any food allergies that your child has:
Your answer
My child (children) listed above have my permission to attend the Vacation Bible School Program at College Street Baptist Church *
My child (children) listed above have my permission to ride the College Street Church bus if offered in my area *
Pick up locations: Country Ridge, Standpoint Vista, Walhalla Gardens, and Wagner Circle
Parent/Guardian Signture *
Submitting this form will serve as parent/guardian signature that your child (children) can attend College Street Baptist Church Vacation Bible School Program 2017. Please type your First and Last Name
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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