Vacation Bible School Registration

Registration Form
1st Child's Name:*

First NameLast Name
2nd Child's Name:

First NameLast Name
3rd Child's Name:

First NameLast Name
Birth Date 1st Child:*

MonthDayYear
Birth Date 2nd Child:

MonthDayYear
Birth Date 3rd Child:

MonthDayYear
Age 1st Child:*
Age 2nd Child:
Age 3rd Child:
Grade Completed 1st Child:*
Grade Completed 2nd Child:
Grade Completed 3rd Child:

Parent/Gardian:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone:*

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:*

Emergency Contact:*

First NameLast Name
Emergency Contact Phone:*

Area CodePhone Number
Who is Picking up Child:
Special Needs / Alergies / Concerns:

Parental Consent

I hereby consent to let my child participate in the event Zommerang Vacation Bible School, July 10 thru 14, 6:00-8:15 PM. It is understood that every precaution will be taken for the safety and well-being of my child, but in the event of accident or sickness, New Hope Baptist Church, its staff, and its volunteers are hereby released from any liability.
Parent/Guardian's Name:*

First NameLast Name
Date:

MonthDayYearHourMinutesAM/PM Option
By submitting this form, I give consent to New Hope Baptist Church of the child(ren) above
Should be Empty:

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