Lighthouse Baptist Church

VBS 2025

1 Per Child
Childs Name*

First NameLast Name
Childs Current Age*
Childs Date Of Birth*

MonthDayYear
Date
Last school grade completed *
FemaleMale
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

Town / CityState

Postal Code
Phone Number*
E-mail*
example@example.com
Home Church
Allergies or other medical conditions:
In case of emergency, contact: First Name*   Last Name*
Phone:   Phone Number*
Relationship to child:   RTC*
YesNoOther
Should be Empty:

VBS 2025