Salem Baptist VBS 2022

Salem Baptist Church VBS Registration June 12 - 16, 2022 5:30-8:30pm

Ages: Completed prek-4 through 5th grade
Child Information *
Does your child have food allergies or medical / special needs that we need to be aware of? *
Please list allergies, special needs, or medical issues here.
If registering multiple children, please specify which child has allergies, special needs, etc.
Parent / Guardian Name *

First Name Last Name
Parent/Guardian Email *
Parent / Guardian Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent / Guardian Phone *

Area Code Phone Number
Alternate Phone

Area Code Phone Number
Home Church
Emergency Contact Name *
Emergency Contact Phone *

Area Code Phone Number
Emergency Contact Relationship to Child *
Comments
You have my permission and consent for my child to attend VBS, to participate in its activities, to receive emergency treatment if necessary and to allow photographs and videos to be taken and published and used to illustrate, promote, and advertise activities at Salem Baptist Church. In signing below, I acknowledge that I have read and understand these instructions.
Signature Parent/Guardian *
Should be Empty: