VBS Registration Form

VBS Registration Form

Winfield First Baptist Church - June 13-17, 2022
Ages: Must be five years old by Sept. 2, 2022 through completed 6th Grade.
Child #1
Child's Name

First Name Last Name
Child's Birthdate

Month Day Year
Last Grade Completed
Medical Information
Medical or other information we should know, including any food or other allergies.
Child #2
Child's Name

First Name Last Name
Child's Birthdate

Month Day Year
Last Grade Completed
Medical Information
Medical or other information we should know, including any food or other allergies.
Child #3
Child's Name

First Name Last Name
Child's Birthdate

Month Day Year
Last Grade Completed
Medical Information
Medical or other information we should know, including any food or other allergies.
Child #4
Child's Name

First Name Last Name
Child's Birthdate

Month Day Year
Last Grade Completed
Medical Information
Medical or other information we should know, including any food or other allergies.
Parent or Guardian's Name *
Address *

Street Address

Mailing Address - If Different

City State / Province

Postal / Zip Code
Parent's Phone Number
Please enter a valid phone number.
Other Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email Address
example@example.com
Emergency Contacts (Other than listed above)
Please supply name(s) and phone numbers
Dismissal Information - Will someone else pick up your child/children at the end of the day? *

Yes No
If yes, who may pick up your child at the end of VBS day?
Please list names
Other Information
Does your child/children attend church regularly? *

Yes No
If yes, where?
Does your child/chidren presently have symptoms or sickness of any kind? (fever, nausea, etc.)? *

Yes No
Has your child/children presently been exposed to persons diagnosed with or exhibiting symptoms of Covid-19?

Yes No
If the answer is "Yes" to either of the above questions, that child will not be able to attend VBS.
Signature

Clear
Please verify that you are human *
Should be Empty:

VBS Registration Form

Ages: Must be five years old by Sept. 2, 2022 through completed 6th Grade.

If the answer is "Yes" to either of the above questions, that child will not be able to attend VBS.