2025 Calcedonia Baptist VBS
Please fill out one form for each child.
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
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1920
Year
Gender
*
Male
Female
Grade going into in August 2025
*
Parent Phone Number
*
Primary Guardian
*
First Name
Last Name
Parent E-mail
*
example@example.com
Alternate phone number
*
Please enter a valid phone number.
Emergency Contact - Please list the first and last names, along with phone numbers of ALL adults who are allowed to pick up your child. The child will only be released to names on this list.
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home church
Does your child have any allergies?
*
Yes
No
Please use box below to describe any allergies or medical information needed. *If any self-carry medication is needed, please also explain below. (epi-pen, inhalers, etc.)
VBS photos and videos are taken and posted to our church social media (facebook). Do you allow your child to be included in these photos?
*
Yes
No
Please provide any additional information we should know about your child.
Submit
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