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Register Your Child for VBS (4 Years - Completed 5th Grade)
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Parent/Guardian First Name
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Parent/Guardian Last Name
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Email
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Phone Number
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Street Address
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City
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State
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County
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Zip Code
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Child's First and Last Name
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Child's Preferred Name
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Child's Birthdate
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Child's Gender
Male
Female
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Child's Grade Completed
Completed Pre K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
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Child's Age
4 years old
5 years old
6 years old
7 years old
8 years old
9 years old
10 years old
11 years old
12 years old
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Does Your Child Have Any Food Allergies? (We Will Provide Snacks)
Yes
No
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If 'Yes' Please Explain:
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Emergency Contact Name (In Addition To Parent/Guardian)
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Emergency Contact Phone Number
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Name/Phone Number Of Others Authorized To Pick Up Your Child
Do You Attend Church
Yes
No
If 'Yes', Where?
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Do We Have Permission To Photograph Your Child For Promotional Materials?
Yes
No
Would You Like Your Child To Be Paired With Another Child?
Yes
No
If 'Yes' Please Name
SUBMIT
One Day VBS! (4 Years - Completed 5th Grade)
Jul 30, 8:30 AM – 2:00 PM
Immanuel Baptist Church
