VBS 2022 First Baptist Church Washington Registration Form

VBS at First Baptist Church Washington

Dates: July 11th - 14th, 2022; Time: 9:00am-Noon, 113 North Harvey Street, Washington, NC; Ages 4 yr old -rising 6th grade (Child must be 4 by July 31st)
Child's Name *

First Name Last Name
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Contact /Emergency Information:

First Name*   Last Name*      Phone Number*

First Name*   Last Name*      Phone Number*
Child's Birth Date (must be 4 yrs old by July 31st, 2022) *
Grade the Child will be Entering in August 2022 *
Dismissal Information: Who may pick up your child at the end of each VBS day?

First Name*   Last Name*      Phone Number*

First Name*   Last Name*      Phone Number*
Medical Information: Medical or other information we need to know. (Please include any food allergies - if your child has severe food allergies or follows a specific diet, we ask that you send a prepared snack with your child.)
Your child may request one friend to be in a group with:
Does your child attend a local church?
If yes, which church?
May we have permission to photograph your child? *
May we have permission to use your child's photograph for social media purposes? *
Should be Empty:

VBS at First Baptist Church Washington