VBS REGISTRATION
Bethel Baptist Church
KICK OFF - July 24 11am-2pm, VBS - July 26-30 6-8pm
Child Information
1st Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Last Grade Completed in School
Please Select
Pre-K (Must be going into Kindergarten)
Kindergarten
1st
2nd
3rd
4th
5th
Medical Information - Please list allergies, medical, or any other information we need to know about.
Child 2
2nd Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Last Grade Completed in School
Please Select
Kindergarten
1st
2nd
3rd
4th
6th
Medical Information - Please list allergies, medical, or any other information we need to know about.
Child 3
3rd Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Last Grade Completed in School
Please Select
Pre-K (Must be going into Kindergarten)
Kindergarten
1st
2nd
3rd
4th
5th
Medical Information - Please list allergies, medical, or any other information we need to know about.
Child 4
4th Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Last Grade Completed in School
Please Select
Pre-K (Must be going into Kindergarten)
Kindergarten
1st
2nd
3rd
4th
5th
Medical Information - Please list allergies, medical, or any other information we need to know about.
Child 5
5th Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Last Grade Completed in School
Please Select
Pre-K (Must be going into Kindergarten)
Kindergarten
1st
2nd
3rd
4th
5th
Medical Information - Please list allergies, medical, or any other information we need to know about.
COLLAPSE STOPPER
Contact Information
1st Parent/Guardian's Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
2nd Parent/Guardian's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address ( If different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contacts
Emergency Contact #1
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Emergency Contact #2
First Name
Last Name
Phone Number
Please enter a valid phone number.
Who may pick up your child?
*
Other Information
Does your family attend Sunday School? If so, where?
If you are visiting, who are you a guest of?
May we have permission to photograph your child(ren)?
*
Yes
No
May we have permission to share photos with your child in it to our public Facebook page? (Bethel Baptist Church)
*
Yes
No
Submit
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