VBS Registration Form
Winfield First Baptist Church - June 5 - 9, 2023
Ages: Must be five years old by Sept. 2, 2023 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
*
Submit
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